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Early Human Development 89S4 (2013) S94S95

Bronchiolitis: update on the management

Eugenio Baraldi *, Dania El Mazloum, Michela Maretti, Francesca Tirelli, Laura Moschino

Womens and Childs Health Department, Pediatric Respiratory Medicine and Allergy Unit, University of Padova, Italy

A R T I C L E I N F O A B S T R A C T

Keywords:

Bronchiolitis

RSV

Nebulized hypertonic salineHigh-flow nasal cannula (HFNC) oxygen

therapy

Bronchiolitis is the main cause of lower respiratory tract infection and hospitalization during the first year of

life. It may occasionally lead to respiratory failure requiring admission to an intensive care unit. Until now,

supportive therapy with O2 and hydration has been the main approach recommended by the international

guidelines, while the role of pharmacological treatment is still debated. Novel therapeutic strategies, such asnebulized hypertonic saline and high-flow oxygen therapy, have been proposed in recent years. The lack of

effective treatments for bronchiolitis makes prevention particularly important in reducing the impact of this

disease, especially in subjects at risk (i.e. preterm infants with BPD, congenital heart disease, or immunodefi-

ciency).

2013 Elsevier Ireland Ltd. All rights reserved.

Acute bronchiolitis is the most common infection of the lower

respiratory tract in infants and the leading cause of hospital ad-

mission within the first year of life (affecting 24% of all children),

occasionally even requiring admission to an intensive care unit.

Children under 6 months old or with pre-existing risk factors, such

as prematurity, bronchopulmonary dysplasia, cystic fibrosis, con-

genital heart disease, structural or functional airway abnormalities,Down syndrome, neuromuscular syndromes or immunodeficien-

cies, are at greater risk of more severe bronchiolitis, hospitalization

and mortality. The most frequently involved pathogen is respira-

tory syncytial virus (RSV), but other respiratory viruses such as

rhinovirus (RV) and metapneumovirus (MPV) have been implicated

too, often as a co-infection.

The diagnosis focuses on two main aspects: (1) clinical findings

on physical examination (runny nose, cough, bronchospasm, rales,

dyspnea, tachypnea, feeding difficulties, apnea, lethargy) and the

patients medical history; and (2) etiology, which is important

to avoid any pointless use of antibiotics and reduce the risk of

nosocomial transmission. The methods generally used to isolate the

virus(es) are Antigen or Genome Detection tests (PCR).

Hospitalization is recommended for children under 3 monthsold, also because of the risk of central apneas when O2 therapy

(SaO2

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Table 1

Clinical implication

Supportive therapy

Oxygen Mainstay of therapy in patients with SaO2