Improving Evidence Based Bronchiolitis Care

Abstract

publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active. Abstract:Bronchiolitis is the number one cause of hospitalization in infants during the first year of life. Clinical guidelines recom mend primarily supportive care and discourage use of pharmacotherapies and diagnostics. However, there con tinues to be widespread use of nonrecommended therapies and variation in the use of therapeutic interventions among hospitals in the United States.Here we review evidence-based man agement of this common disease in order to optimize resource utilization, decrease healthcare costs, and de crease unnecessary hospitalization. Current evidence does not support the routine use of chest radiographs, viral testing or laboratory evaluation in chil dren with bronchiolitis. In addition, rou tine administration of bronchodilators, including albuterol and nebulized epi nephrine, corticosteroids and hypertonic saline are not recommended for infants and children with bronchiolitis. Intrave nous or nasogastric hydration and nutri tional support, supplemental oxygen, and respiratory support are recom mended. Standardization of bronchiolitis care with evidence based institutional clinical pathways spanning ED to inpa tient care can help optimize resource utilization while simultaneously improv ing care of bronchiolitis and reducing hospital length of stays and costs.

Worldwide research trends on bronchiolitis in pediatrics

“…There is, therefore, an apparent change in trend, given that in the early years, publications focused on origin and survival. However, in the most recent publications, the overall interest is more focused on specific treatments, such as positive pressure or high‐flow nasal cannula, 32 and the performance of evidence‐based clinical studies 33 …”

“…However, in the most recent publications, the overall interest is more focused on specific treatments, such as positive pressure or high-flow nasal cannula, 32 and the performance of evidence-based clinical studies. 33…”

Epidemiology of Bronchiolitis in Hospitalized Infants at Tawam Hospital, Al Ain, United Arab Emirates

“…Some of our patients received different treatment modalities like bronchodilators. Bronchodilators are less likely to be recommended in more recent guidelines, and the theory that they may be of greater benefit in infants more likely to develop asthma has been refuted [51,52] The limitation of our study is its retrospective nature. In addition, concomitant bacterial infection and viral genomic load have not been measured.…”

Prevalence and Outpatient Clinical Diagnostic Approaches for Common Acute Respiratory Tract Infections in Children Under Five Years of Age: A Cross-Sectional Study

“… Asthma (*excluded from the study) Asthma diagnosis was made based on the Global Initiative for Asthma (GINA) guidelines 2019 8 in any child with; History Wheezing/coughing with exercise, laughing in the absence of respiratory infection, occurring more at night or in the morning History of other allergic diseases for example eczema, allergic rhinitis, asthma in the first degree relative or allergen sensitization Exclusions We excluded the symptom of “chest tightness” because young children are not able to express this symptom objectively Measure of peak flow and/or spirometry because children under five years cannot perform these tests appropriately Bronchiolitis Bronchiolitis was defined as the first episode of wheezing in a child less than 24 months of age, presenting with at least one of the signs and symptoms of cough, running nose and/or difficulty breathing, and respiratory distress. 9 , 10 Chest radiography (X-ray) findings of hyperinflation ruled out pneumonia. Common cold This was defined as the presence of a cough, nasal discharge, +/- fever, no signs of pneumonia or severe pneumonia, bronchiolitis, and no stridor when a child is calm.…”