U.S. researchers reviewed data from multiple studies and offered several
tips for identifying and caring for infants with bronchiolitis, including
limiting the use of lab and radiographic tests and investigating alternative
treatments to bronchodilators and corticosteroids, as recommended by the
American Academy of Pediatrics.
Multiple studies have documented variation in diagnostic testing,
treatment, hospitalization rates and length of hospital stay for bronchiolitis,
suggesting a lack of consensus and an opportunity to improve care for this
common disorder, wrote Joseph J. Zorc, MD, of the Childrens
Hospital of Philadelphia, and Caroline B. Hall, MD, an Infectious
Diseases in Children Editorial Board member from the University of
Rochester School of Medicine and Dentistry, in a recently published article.
Bronchiolitis remains the leading cause of infant hospitalization in the
United States, and data suggests that associated morbidity rates and cost have
increased over recent decades.
Current research indicates that infants aged younger than 6 months with
prematurity and underlying cardiopulmonary disease or immunodeficiency are at
higher risk for severe bronchiolitis or death. Therefore identifying these risk
factors is important for assessing disease progression, according to the
Pulse oximetry is another important measure of severity. In one study, a
pulse oximetry level <94% was associated with more than a fivefold increase
in the likelihood of hospitalization. Data from other studies indicated that
lag time for oxygen saturation contributed to lengthier hospital stays.
After examining research about the efficacy of diagnostic tools, the
researchers argued against the use of chest radiography. One studys
findings indicated that routine radiography did not improve diagnosis of
bronchiolitis. Furthermore, clinicians who used radiographs often
Data involving lab testing also showed that rapid viral antigen tests
were not associated with improved bronchiolitis diagnoses. These tests appeared
to have better sensitivity and specificity during peak viral season, according
to the researchers, making them less effective outside of that particular
The reviewers also examined the results of bronchodilators and
corticosteroids in the treatment of bronchiolitis. Recent research indicated no
significant decreases in hospitalization rates or length of hospitalizations
for either bronchodilators or corticosteroids. Other therapies, such as
nebulized hypertonic saline, are still being evaluated.
New molecular diagnostic techniques showed respiratory syncytial virus
(50% to 80% of cases), human metapneumovirus, parainfluenza viruses and
influenza as major causes of bronchiolitis, with coinfection rates ranging from
10% to 30% in samples of hospitalized children.
The reviewers concluded that these research findings supported
recommendations put forth by the AAP regarding diagnosis and management of
bronchiolitis. However, they wrote that additional research is necessary
to explore the combination of these therapies and other
Zorc JJ. Pediatrics. 2010;125:342-349.