Bronquiolitis

Evidence-Based Care Guideline For Infants with Bronchiolitis James M. Anderson Center for Health Systems Excellence

Guideline 1

Evidence-Based Care Guideline

Management of first time episode

Bronchiolitis
in infants less than 1 year of age
Current Revision Publication Date: November 16, 2010 Revision Publication Dates: August 15, 2005, November 28, 2001 Original Publication Date:December 6, 1996
Please cite as: Bronchiolitis Guideline Team, Cincinnati Children's Hospital Medical Center: Evidence-based care guideline for management of bronchiolitis in infants 1 year of age or less with a first time episode, Bronchiolitis Pediatric Evidence-Based Care Guidelines, Cincinnati Children's Hospital Medical Center , Guideline 1, pages 1-16, 2010.

Bronchiolitis is the number onecause of hospitalizations in U.S. infants less than one year of age. Total annual costs for bronchiolitis-related hospitalizations were $543 million, with a mean cost of $3799 per hospitalization when analyzed by the 2002 Health-Care Utilization Project (Pelletier 2006 [4a]). These hospitalizations account for 1.4 million inpatient care days and 718,008 Emergency Department visits. The nationalaverage duration of hospitalization is 3.9 days. Local experience at the time of publication is 2.0 days. RSV-associated deaths account for less than 400 infant deaths per year in the U.S. The risk factors for death from bronchiolitis are prematurity, low birth weight, black race, young maternal age, and smoking during pregnancy (data analysis via the National Hospital
Ambulatory Medical CareSurvey data; National Hospital Discharge Survey data, 1997 to 2000 and Perinatal Mortality Linked Files 1998 to 1999) (Leader 2003 [4a]).

Target Population
Inclusion: Intended primarily for use in children:  age less than 1 year and presenting for the first time with bronchiolitis typical in presentation and clinical course Exclusion: Not intended for use in children:  with a history of cysticfibrosis (CF)  with a history of bronchopulmonary dysplasia (BPD)  with immunodeficiencies  admitted to an intensive care unit (ICU)  requiring ventilator care  with other severe comorbid conditions complicating care

Most infants who contract bronchiolitis recover without sequelae; however, subsequent wheezing episodes have been found in older children who were hospitalized forbronchiolitis in infancy (van Woensel 2000 [2b], Sigurs 2004 [3a], Sigurs 2002 [3a]). It is still not known, however, whether RSV bronchiolitis in infancy by itself causes the post-bronchiolitic wheezing symptoms or whether some inherent factor in the child contributes both to the bronchiolitis and to the subsequent wheezing (Sigurs 2004 [3a], Panitch 2007 [5a]). Despite the commonality of bronchiolitis,considerable confusion and variability with respect to the clinical management of these infants remains (Knapp 2010 [4a], Knapp 2008 [4a], Conway 2006 [4a], Christakis 2005 [4a]). Typical bronchiolitis in infants is a self-limited viral disease that is little modified by aggressive evaluations, use of antibiotics or other therapies (Knapp 2008 [4a], Christakis 2005 [4a], Mansbach 2005 [4a]). Severalstudies on the use of clinical guidelines for the management of infant bronchiolitis have shown a reduction in unnecessary resource utilization with streamlining of medical care for these infants (Barben 2008
[4a], Muething 2004 [4a], Kotagal 2002 [4a], Harrison 2001 [4a], Perlstein 2000 [4a], Perlstein 1999 [4a]).

Target Users
Includes but is not limited to (in alphabetical order):  Patient/ family  Patient care staff  Physicians

Introduction
References in parentheses ( ). Evidence strengths in [ ]. (See last page for definitions.)

Bronchiolitis is an acute inflammatory disease of the lower respiratory tract, resulting from obstruction of small airways. It is initiated by infection of the upper respiratory tract by any one of a number of seasonal viruses. The most common...