title: Inter-society consensus document on treatment and prevention of bronchiolitis in newborns and infants.
abstract: Acute bronchiolitis is the leading cause of lower respiratory tract infection and hospitalization in children less than 1 year of age worldwide. It is usually a mild disease, but some children may develop severe symptoms, requiring hospital admission and ventilatory support in the ICU. Infants with pre-existing risk factors (prematurity, bronchopulmonary dysplasia, congenital heart diseases and immunodeficiency) may be predisposed to a severe form of the disease. Clinical diagnosis of bronchiolitis is manly based on medical history and physical examination (rhinorrhea, cough, crackles, wheezing and signs of respiratory distress). Etiological diagnosis, with antigen or genome detection to identify viruses involved, may have a role in reducing hospital transmission of the infection. Criteria for hospitalization include low oxygen saturation (<90-92%), moderate-to-severe respiratory distress, dehydration and presence of apnea. Children with pre-existing risk factors should be carefully assessed.To date, there is no specific treatment for viral bronchiolitis, and the mainstay of therapy is supportive care. This consists of nasal suctioning and nebulized 3% hypertonic saline, assisted feeding and hydration, humidified O2 delivery. The possible role of any pharmacological approach is still debated, and till now there is no evidence to support the use of bronchodilators, corticosteroids, chest physiotherapy, antibiotics or antivirals. Nebulized adrenaline may be sometimes useful in the emergency room. Nebulized adrenaline can be useful in the hospital setting for treatment as needed. Lacking a specific etiological treatment, prophylaxis and prevention, especially in children at high risk of severe infection, have a fundamental role. Environmental preventive measures minimize viral transmission in hospital, in the outpatient setting and at home. Pharmacological prophylaxis with palivizumab for RSV bronchiolitis is indicated in specific categories of children at risk during the epidemic period. Viral bronchiolitis, especially in the case of severe form, may correlate with an increased incidence of recurrent wheezing in pre-schooled children and with asthma at school age.The aim of this document is to provide a multidisciplinary update on the current recommendations for the management and prevention of bronchiolitis, in order to share useful indications, identify gaps in knowledge and drive future research.
authors.affiliation: SIMRI-Società Italiana per le Malattie Respiratorie Infantili, Italy. baraldi@pediatria.unipd.it.
authors.forename: Eugenio
authors.initials: E
authors.lastname: Baraldi
authors.forename: Marcello
authors.initials: M
authors.lastname: Lanari
authors.forename: Paolo
authors.initials: P
authors.lastname: Manzoni
authors.forename: Giovanni A
authors.initials: GA
authors.lastname: Rossi
authors.forename: Silvia
authors.initials: S
authors.lastname: Vandini
authors.forename: Alessandro
authors.initials: A
authors.lastname: Rimini
authors.forename: Costantino
authors.initials: C
authors.lastname: Romagnoli
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Colonna
authors.forename: Andrea
authors.initials: A
authors.lastname: Biondi
authors.forename: Paolo
authors.initials: P
authors.lastname: Biban
authors.forename: Giampietro
authors.initials: G
authors.lastname: Chiamenti
authors.forename: Roberto
authors.initials: R
authors.lastname: Bernardini
authors.forename: Marina
authors.initials: M
authors.lastname: Picca
authors.forename: Marco
authors.initials: M
authors.lastname: Cappa
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Magazzù
authors.forename: Carlo
authors.initials: C
authors.lastname: Catassi
authors.forename: Antonio Francesco
authors.initials: AF
authors.lastname: Urbino
authors.forename: Luigi
authors.initials: L
authors.lastname: Memo
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Donzelli
authors.forename: Carlo
authors.initials: C
authors.lastname: Minetti
authors.forename: Francesco
authors.initials: F
authors.lastname: Paravati
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Mauro
authors.forename: Filippo
authors.initials: F
authors.lastname: Festini
authors.forename: Susanna
authors.initials: S
authors.lastname: Esposito
authors.forename: Giovanni
authors.initials: G
authors.lastname: Corsello
mesh_terms: D058672:Adrenergic beta-2 Receptor Antagonists / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use; D001988:Bronchiolitis / Q000175:diagnosis / Q000628:therapy*; D001993:Bronchodilator Agents / Q000627:therapeutic use; D003657:Decision Making; D004781:Environmental Exposure / Q000517:prevention & control; D004837:Epinephrine / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use; D006760:Hospitalization; D006801:Humans; D006813:Humidity; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D009330:Nebulizers and Vaporizers; D010102:Oxygen Inhalation Therapy; D000069455:Palivizumab; D010351:Patient Discharge; D011320:Primary Health Care; D012138:Respiratory Therapy; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage; D012720:Severity of Illness Index; D014807:Vitamin D / Q000627:therapeutic use; D014815:Vitamins / Q000627:therapeutic use
chemical_list: D058672:Adrenergic beta-2 Receptor Antagonists; D000900:Anti-Bacterial Agents; D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents; D001993:Bronchodilator Agents; D005938:Glucocorticoids; D012462:Saline Solution, Hypertonic; D014815:Vitamins; D014807:Vitamin D; D000069455:Palivizumab; D004837:Epinephrine