Controversies in the management of children with bronchiolitis

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Abstract

In this review, we present and summarize data from recently conducted research regarding controversial aspects of the management of children with bronchiolitis. These data suggest that chronic medical history, gestational age at birth, postnatal age, and physiological variables can identify those children at higher risk for a more severe course of bronchiolitis. Large prospective studies also suggest that the likelihood of significant bacterial illness in febrile infants with bronchiolitis may be lower than in children without bronchiolitis. Nevertheless, urinary tract infections remain relatively common in young febrile children with bronchiolitis. Lastly and unfortunately, the data note a relative lack of effective therapies for children with bronchiolitis, although certain therapies such as systemic corticosteroids show potential efficacy and are in need of further study. The remaining uncertainty surrounding many issues pertaining to bronchiolitis highlight the need for more research aimed to: (1) develop prognostic models to identify patients at risk for a more severe clinical course, (2) develop generalizable diagnostic models to identify febrile infants with bronchiolitis at high and very low risk of significant bacterial illness, and (3) evaluate the effectiveness of promising therapies.

Section snippets

Prognosis question

In the ED, we would like to accurately predict which children with bronchiolitis are likely to have a more severe course in order to more precisely determine which children need admission to the general inpatient service or intensive care unit. It is difficult, however, to identify unbiased, clinically-relevant outcomes that clearly define a severe course. We focus on the following outcomes: death, mechanical ventilation, admission to the general inpatient service, and admission or transfer to

Summary

Recently-conducted research has started to help answer clinical questions that frequently arise in the management of children with bronchiolitis. We have presented data to help clarify which risk factors place a patient at higher risk for a more severe clinical course, the likelihood of significant bacterial illness in febrile infants with bronchiolitis, and the efficacy of individual therapies for bronchiolitis. More research is needed, however, to develop clinically useful and generalizable

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