Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis

Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis

abstract This guideline is a revision of the clinical practice guideline, “Diagnosis and Management of Bronchiolitis,” published by the American Academy of Pediatrics in 2006. The guideline applies to children from 1 through 23 months of age. Other exclusions are noted. Each key action state- ment indicates level of evidence, benefit-harm relationship, and level of recommendation. Key action statements are as follows: Pediatrics 2014;134:e1474–e1502

DIAGNOSIS

1a. Clinicians should diagnose bronchiolitis and assess disease se- verity on the basis of history and physical examination (Evidence Quality: B; Recommendation Strength: Strong Recommendation).

1b. Clinicians should assess risk factors for severe disease, such as age less than 12 weeks, a history of prematurity, underlying car- diopulmonary disease, or immunodeficiency, when making decisions about evaluation and management of children with bronchiolitis (Evidence Quality: B; Recommendation Strength: Moderate Rec- ommendation).

1c. When clinicians diagnose bronchiolitis on the basis of history and physical examination, radiographic or laboratory studies should not be obtained routinely (Evidence Quality: B; Recommendation Strength: Moderate Recommendation).

TREATMENT

2. Clinicians should not administer albuterol (or salbutamol) to in- fants and children with a diagnosis of bronchiolitis (Evidence Qual- ity: B; Recommendation Strength: Strong Recommendation).

3. Clinicians should not administer epinephrine to infants and children with a diagnosis of bronchiolitis (Evidence Quality: B; Recommen- dation Strength: Strong Recommendation).

4a. Nebulized hypertonic saline should not be administered to in- fants with a diagnosis of bronchiolitis in the emergency depart- ment (Evidence Quality: B; Recommendation Strength: Moderate Recommendation).

4b. Clinicians may administer nebulized hypertonic saline to infants and children hospitalized for bronchiolitis (Evidence Quality: B; Recommendation Strength: Weak Recommendation [based on ran- domized controlled trials with inconsistent findings]).

Shawn L. Ralston, MD, FAAP, Allan S. Lieberthal, MD, FAAP, H. Cody Meissner, MD, FAAP, Brian K. Alverson, MD, FAAP, Jill E. Baley, MD, FAAP, Anne M. Gadomski, MD, MPH, FAAP, David W. Johnson, MD, FAAP, Michael J. Light, MD, FAAP, Nizar F. Maraqa, MD, FAAP, Eneida A. Mendonca, MD, PhD, FAAP, FACMI, Kieran J. Phelan, MD, MSc, Joseph J. Zorc, MD, MSCE, FAAP, Danette Stanko-Lopp, MA, MPH, Mark A. Brown, MD, Ian Nathanson, MD, FAAP, Elizabeth Rosenblum, MD, Stephen Sayles III, MD, FACEP, and Sinsi Hernandez-Cancio, JD

KEY WORDS bronchiolitis, infants, children, respiratory syncytial virus, evidence-based, guideline

ABBREVIATIONS AAP—American Academy of Pediatrics AOM—acute otitis media CI—confidence interval ED—emergency department KAS—Key Action Statement LOS—length of stay MD—mean difference PCR—polymerase chain reaction RSV—respiratory syncytial virus SBI—serious bacterial infection

This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication.

The recommendations in this report do not indicate an exclusive course of treatment or serve as a standard ofmedical care. Variations, taking into account individual circumstances, may be appropriate.

All clinical practice guidelines from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

Dedicated to the memory of Dr Caroline Breese Hall.