Guidelines Summary

AAP releases updated guidelines for pediatric bronchiolitis

The American Academy of Pediatrics has released updated guidelines on the diagnosis, treatment, and prevention of bronchiolitis in children aged 1 to 23 months. The new guidelines emphasize the use of supportive care, including hydration and oxygen.^{[230, 110]}Other recommendations include the following:

As multiple viruses may cause bronchiolitis, testing for specific viruses is not necessary.
Routine radiographic or laboratory studies are also not necessary. Diagnosis and assessment of bronchiolitis severity should be based on patient history and physical examination.
There is no need for a trial dose of a bronchodilator.
Otherwise healthy infants with gestational age of 29 weeks or more should not receive palivizumab to prevent respiratory syncytial virus infections. Infants under one year of age with hemodynamically significant heart disease or chronic lung disease of prematurity should be treated with palivizumab, up to a maximum of 5 monthly doses, during the respiratory syncytial virus season.
Risk factors for severe disease include age less than 12 weeks, prematurity, underlying cardiopulmonary disease, and immunodeficiency.
Epinephrine and chest physiotherapy should not be administered to infants and children with bronchiolitis.

The following guidelines may be helpful:

American Academy of Pediatrics -Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis.^[110]
American Academy of Pediatrics Committee on Infectious Diseases; American Academy of Pediatrics Bronchiolitis Guidelines Committee. Updated guidance for palivizumab prophylaxis among infants and young children at increased risk of hospitalization for respiratory syncytial virus infection.^[219]
American College of Chest Physicians -Chronic cough due to nonbronchiectatic suppurative airway disease (bronchiolitis): ACCP evidence-based clinical practice guidelines^[231]

Medication

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Media Gallery

A chest radiography revealing lung hyperinflation with a flattened diaphragm and bilateral atelectasis in the right apical and left basal regions in a 16-day-old infant with severe bronchiolitis. Image courtesy of Wikipedia Commons.
Electron micrograph of respiratory syncytial virus (RSV). Image courtesy of Wikipedia Commons.
Airway anatomy showing bronchioles. Image courtesy of Wikipedia Commons.

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Author

Nizar F Maraqa, MD, FAAP, FPIDS Associate Professor of Pediatric Infectious Diseases, Fellowship Program Director for Pediatric Infectious Diseases, Residency Associate Program Director for Pediatrics, Chief Information Officer, Division of Infectious Diseases, Department of Pediatrics, University of Florida College of Medicine-Jacksonville; Medical Director, University of Florida Center for HIV/AIDS Research, Education, and Service (UF CARES); Medical Director of Pediatric Informatics, Wolfson Children’s Hospital, Baptist Health of Northeast Florida

Nizar F Maraqa, MD, FAAP, FPIDS is a member of the following medical societies: American Academy of Pediatrics, Jordan Medical Association, Pediatric Infectious Diseases Society, Pediatric Society - Palestine

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Additional Contributors

Lucian Kenneth DeNicola, MD, MS, FAAP, FCCM Professor, Department of Pediatrics, University of Florida Health Science Center at Jacksonville

Lucian Kenneth DeNicola, MD, MS, FAAP, FCCM is a member of the following medical societies: American Academy of Pediatrics, American College of Critical Care Medicine, Florida Medical Association, Society of Critical Care Medicine, Florida Chapter of The American Academy of Pediatrics, Florida Pediatric Society

Disclosure: Nothing to disclose.

John Udeani, MD, FAAEM Assistant Professor, Department of Emergency Medicine, Charles Drew University of Medicine and Science, University of California, Los Angeles, David Geffen School of Medicine

John Udeani, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Haidee T Custodio, MD Associate Professor, Department of Pediatrics, Division of Pediatric Infectious Diseases, University of South Alabama College of Medicine

Haidee T Custodio, MD is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, Pediatric Infectious Diseases Society

Disclosure: Local Principal Investigator for a clinical trial for: Allergan.

Acknowledgements

Kirsten A Bechtel, MD Associate Professor, Department of Pediatrics, Yale University School of Medicine; Attending Physician, Department of Pediatric Emergency Medicine, Yale-New Haven Children's Hospital

Kirsten A Bechtel, MD is a member of the following medical societies: American Academy of Pediatrics