NICE clinical guideline: bronchiolitis in children: Table 1

Osvald, Emma Caffrey; Clarke, JR

doi:10.1136/archdischild-2015-309156

Cited by 50 publications

(40 citation statements)

References 10 publications

(7 reference statements)

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“…(5, 23, 24) These guidelines provide recommendations in terms of prevention, diagnosis, admission criteria, and management of hospitalized children with bronchiolitis with little or no information regarding discharge criteria, which may contribute to the wide variability in length of stay reported among different studies. (2, 4, 8, 10, 25, 26)…”

Section: Discussionmentioning

confidence: 99%

“…(1) Different guidelines for the management of children with bronchiolitis have been published. (2–4) Most of these guidelines are focused on admission criteria and the value (or not) of different therapeutic interventions during hospitalization. However, there are no standardized protocols for the discharge of infants and young children with bronchiolitis.…”

Section: Introductionmentioning

confidence: 99%

“…(5–7) However, oxygen weaning pathways, as well as the desired thresholds for oxygen discontinuation vary according to the different guidelines. (4, 8–10) These factors may contribute to the wide variability in length of stay reported among different institutions, both in USA and across the world. (11, 12) Standardizing clinical criteria for bronchiolitis is especially relevant in an era where new interventions for prevention and treatment of RSV infection are being evaluated in clinical studies.…”

Section: Introductionmentioning

confidence: 99%

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Discharge Criteria for Bronchiolitis

Garcia-Maurino

Moore‐Clingenpeel

Wallihan

et al. 2018

Pediatric Infectious Disease Journal

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Background: Admission criteria and standardized management strategies for bronchiolitis are addressed in several guidelines and have shown to be beneficial; however, guidance regarding discharge criteria is limited and widely variable. We assessed the impact on clinical outcomes of a discharge protocol for children <2 years of age hospitalized with bronchiolitis in a tertiary care pediatric hospital. Methods: In October 2013, a protocol to standardize the discharge of children with bronchiolitis was implemented in the infectious diseases (ID) ward but not in other pediatric units caring for these children (non-ID). The protocol included objective clinical criteria and a standardized oxygen weaning pathway. Patients were identified via International Classification of Diseases-9 codes and data manually reviewed. We compared length of stay (LOS) and readmission rates within 2 weeks of discharge according to protocol implementation (ID versus non-ID), adjusted for demographic factors, comorbidities, viral etiology and stratified by pediatric intensive care unit admission. Results: From October 2013 to May 2015, 1118 children were hospitalized in ID and 695 in non-ID units. Median age was 4.5 months, 55% were males and 28% had comorbidities. LOS was 36% longer in non-ID units (risk ratio: 1.36 [1.27–1.45]; P < 0.001) adjusted for age, gender, comorbidities and viral etiology. Difference in LOS remained significant after excluding children with comorbidities and stratifying by pediatric intensive care unit admission. Readmission rates were comparable between units (ID, 2.9% versus non-ID, 2.6%). Conclusions: A standardized discharge protocol for bronchiolitis reduced LOS without increasing readmission rates. Unifying bronchiolitis discharge criteria and oxygen weaning pathways could positively impact hospital-based patient care for this condition.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Discharge Criteria for Bronchiolitis

Garcia-Maurino

Moore‐Clingenpeel

Wallihan

et al. 2018

Pediatric Infectious Disease Journal

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“…5 The economic burden among US children requiring hospitalization has been estimated to be $1.73 billion/year. 6 While several diagnostic and therapeutic recommendations for the management of children with bronchiolitis currently exist worldwide, [7][8][9][10][11] these guidelines vary significantly. These variations include several newer therapies for bronchiolitis, such as hypertonic saline, high flow nasal cannula (HFNC), and continuous positive airway pressure (CPAP), for which the evidence supporting their benefit is controversial.…”

mentioning

confidence: 99%

Treatment of severe bronchiolitis: A survey of Canadian pediatric intensivists

Bradshaw

Déragon

Puligandla

et al. 2018

Pediatric Pulmonology

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The management of severe viral bronchiolitis is similar across Canadian PICUs. The use of NIV, inhaled treatments, and antibiotics is frequent, which differs from the recommendations made by published guidelines. Canadian pediatric intensivists use homogeneous PICU admission criteria based on patients' characteristics and severity of the clinical picture. Clinical practice guidelines for children with viral bronchiolitis should address the management of patients with severe clinical disease.

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“…An update of this Cochrane review shows a modest reduction of LOS in inpatients, a mild reduction of hospitalisation risk in outpatients and improvement of clinical severity scores when HS is used, although quality of evidence remains low to moderate . The most recent National Institute for Health and Care Excellence guidelines do not recommend treatment with HS at all following the multi‐centre UK Southall and Brent REvisited (SABRE) study showing no difference in time to being declared fit for discharge in comparison with usual care . Additionally, side effects related to the use of nebulised HS, e.g.…”

mentioning

confidence: 99%

Nebulised hypertonic saline in children with bronchiolitis admitted to the paediatric intensive care unit: A retrospective study

Stobbelaar

Kool

Kruijf

et al. 2019

J Paediatrics Child Health

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Aim Bronchiolitis is one of the most common lower respiratory tract infections in young children, associated with significant morbidity, but limited therapeutic options. Nebulised hypertonic saline (HS) has been a supportive treatment until current guidelines advised against its routine use. Accordingly, the University Hospital of Antwerp recently changed their policies to stop using it, allowing us to evaluate retrospectively if HS influences the duration of respiratory support. Because, to our knowledge, the effect of HS on children with severe bronchiolitis admitted to a paediatric intensive care unit (PICU) has not been studied yet, we aimed to investigate the effect in this specific patient group. Methods Retrospective study including children up to the age of 2, admitted to the PICU with bronchiolitis from October 2013 until March 2016. The primary end point is the duration of respiratory support, including high flow nasal cannula, continuous positive airway pressure and invasive ventilation. Results A total of 104 children admitted to the PICU with bronchiolitis were included, with an average age of 3.4 months. In respiratory syncytial virus (RSV) positive patients, the use of nebulised HS was correlated with a decrease in the duration of respiratory support and the length of stay by factors 0.72 (P = 0.01) and 0.81 (P = 0.04), respectively. Conclusions A significant correlation was found between the use of HS and a decreased duration of respiratory support and admission in the PICU in patients with RSV bronchiolitis. This finding may warrant new prospective studies investigating HS specifically in children with severe bronchiolitis.

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NICE clinical guideline: bronchiolitis in children: Table 1

Cited by 50 publications

References 10 publications

Discharge Criteria for Bronchiolitis

Discharge Criteria for Bronchiolitis

Treatment of severe bronchiolitis: A survey of Canadian pediatric intensivists

Nebulised hypertonic saline in children with bronchiolitis admitted to the paediatric intensive care unit: A retrospective study

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