Management of Pediatric Bronchiolitis

Diagnosis and Characterization

Bronchiolitis is a clinical diagnosis in infants less than 2 years of age that does not require diagnostic testing, characterized by first episode of wheezing associated with respiratory symptoms such as rhinitis, tachypnea, and increased respiratory effort 1
Risk factors for severe disease include age less than 12 weeks, history of prematurity, underlying cardiopulmonary disease, or immunodeficiency 1

Systematic reviews and meta-analyses involving nearly 1200 children have not shown sufficient evidence to support steroid use in bronchiolitis 3

The American Academy of Pediatrics recommends focusing on supportive care and monitoring 1, 2
Assess hydration and ability to take fluids orally (strong recommendation) 1
Provide supplemental oxygen if SpO2 falls persistently below 90% in previously healthy infants 1
Discontinue oxygen when SpO2 is at or above 90% and the infant is feeding well with minimal respiratory distress 1
Avoid routine use of other medications including bronchodilators, antibiotics, and chest physiotherapy 1, 2

Hand decontamination is the most important step in preventing spread of respiratory syncytial virus (RSV) 1
Infants should not be exposed to passive smoking (strong recommendation) 2
Breastfeeding is recommended to decrease a child's risk of having lower respiratory tract disease 2
Palivizumab prophylaxis may be considered for infants with history of prematurity or congenital heart disease 1