BackgroundBronchiolitis is a common respiratory illness of early childhood. For most children it is a mild self-limiting disease but a small number of children develop respiratory failure. Nasal continuous positive airway pressure (nCPAP) has traditionally been used to provide non-invasive respiratory support in these children, but there is little clinical trial evidence to support its use. More recently, high-flow nasal cannula therapy (HFNC) has emerged as a novel respiratory support modality. Our study aims to describe current national practice and clinician preferences relating to use of non-invasive respiratory support (nCPAP and HFNC) in the management of infants (<12 months old) with acute bronchiolitis.MethodsWe performed a cross-sectional web-based survey of hospitals with inpatient paediatric facilities in England and Wales. Responses were elicited from one senior doctor and one senior nurse at each hospital. We analysed the proportion of hospitals using HFNC and nCPAP; clinical thresholds for their initiation; and clinician preferences regarding first-line support modality and future research.ResultsThe survey was distributed to 117 of 171 eligible hospitals; 97 hospitals provided responses (response rate: 83%). The majority of hospitals were able to provide nCPAP (89/97, 91.7%) or HFNC (71/97, 73.2%); both were available at 65 hospitals (67%). nCPAP was more likely to be delivered in a ward setting in a general hospital, and in a high dependency setting in a tertiary centre. There were differences in the oxygenation and acidosis thresholds, and clinical triggers such as recurrent apnoeas or work of breathing that influenced clinical decisions, regarding when to start nCPAP or HFNC. More individual respondents with access to both modalities (74/106, 69.8%) would choose HFNC over nCPAP as their first-line treatment option in a deteriorating child with bronchiolitis.ConclusionsDespite lack of randomised trial evidence, nCPAP and HFNC are commonly used in British hospitals to support infants with acute bronchiolitis. HFNC appears to be currently the preferred first-line modality for non-invasive respiratory support due to perceived ease of use.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-017-0785-0) contains supplementary material, which is available to authorized users.

We thank the paediatric accident and emergency nursing and medical staff and audit department for their help.

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Aims Parenting children with special health care needs and medical complexity can be challenging, and parents may struggle to manage their child's health and their own reactions, contributing to poorer health outcomes for parents, the child and other family members. Frequent healthcare contact however presents opportunities to provide supportive interventions but current review evidence is limited. The objectives were to scope parent and family-based health and well-being interventions amenable to delivery within routine healthcare settings. Methods MEDLINE, EMBASE, PsycINFO, CINAHL, The Cochrane Library, ERIC, ASSIA, HMIC and OpenGrey were searched up to February 2017. 10 154 citations were double screened according to predetermined eligibility criteria. Sixtyfive studies were included. Data on study design, population, measurement tools, results, and use of theory were extracted and summarized. ResultsDiverse examples were found Psychosocial and behaviour change programs, targeted support around hospital admission, parenting programs and peer support were common. Outcomes measured were diverse with 129 outcomes measured using 161 different tools. The most common outcome measured was anxiety in 19 studies (29%), followed by stress (n=12, 18%), depression (n=11, 17%) and coping (n=10, 15%). Interventions were delivered by many different health care professionals and lay workers, indicating that many could be delivered within existing multi-disciplinary teams, and examples of remote and flexible interventions demonstrate that geography or busy schedules do not need to be a barrier to parent participation. Most studies reported some favourable outcomes and use of theory was associated with positive findings. No serious adverse events were reported. Conclusions The range of interventions and targets identified suggests that the impact on parents of caring for a child with a chronic health condition is substantial and diverse, and that there is potential for a range of interventions to improve or mitigate important parent outcomes. One approach is unlikely to meet the needs of all parents and parents may benefit from a number of approaches. Few interventions included parents of children with medical complexity and there is a pressing need for intervention development to support these parents.