MedeliX
Start asking

UPDATE - 2022 Italian guidelines on the management of bronchiolitis in infants

Italian intersociety (SIP et al.) · 2023 · Italy

Source and licence

Authors
Sara Manti, Annamaria Staiano, Luigi Orfeo et al.
Title
UPDATE - 2022 Italian guidelines on the management of bronchiolitis in infants
Journal
Italian Journal of Pediatrics, 2023
DOI
10.1186/s13052-022-01392-6
Licence
CC BY 4.0
Changes
Verbatim excerpts; formatting adapted

Full text retrieved 2026-10-27 from Europe PMC · PMC9912214

Licence statement of the original publication

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.

Open the original publication →Full text on Europe PMC

Recommendations

Verbatim, with grade of recommendation or strength of consensus where given.

How is bronchiolitis diagnosed?

  • RecommendationsThe diagnosis of bronchiolitis is based on the clinical history and physical examinationEvidence Quality: B; Recommendation Strength: Strong Recommendation

What is the role of primary care paediatricians in managing a child with bronchiolitis?

  • RecommendationsPrimary care paediatricians should educate family members on evidence-based prevention, diagnosis, and management of bronchiolitisEvidence Quality: C; Recommendation Strength; Moderate Recommendation

Are laboratory (blood an/or urine) tests and radiological exams supported in managing bronchiolitis?

  • RecommendationsNeither laboratory tests nor radiological exams are usually indicated for the routine work-up of infants with bronchiolitisEvidence Quality: B; Recommendation Strength: Moderate Recommendation

When making decision about the hospitalization of an infant with bronchiolitis?

  • RecommendationsModerate-to-severe bronchiolitis and well-known risk factors for developing severe bronchiolitis must be considered for hospital admissionEvidence Quality: B; Recommendation Strength: Moderate Recommendation

When making decision to transfer to intensive care unit an infant with bronchiolitis?

  • RecommendationsInfants with bronchiolitis and respiratory failure requiring ventilatory support, oxygen saturation (SO2) reduced despite O2 therapy and or HFNC, apnea with desaturation, and severe impairment of general conditions must be transferred to the ICUEvidence Quality: B; Recommendation Strength: Moderate Recommendation

Superficial nasal aspiration

  • RecommendationsA gentle, superficial and reasonably frequent nasal aspiration, especially in younger children, is recommended to improve airway patency, O2 saturation measured by pulse oximetry (SpO2), and feedingEvidence Quality: A; Recommendation Strength: Strong Recommendation

Oxygen therapy

  • RecommendationsSupplemental O2 should be administered if O2 saturation levels are persistently below 92% in room airEvidence Quality: A; Recommendation Strength: Strong Recommendation

Feeding and hydration

  • RecommendationsAdequate feeding and hydration are recommended in treating bronchiolitis since respiratory distress in infants with bronchiolitis can negatively affect the hydration statusEvidence Quality: A; Recommendation Strength: Strong Recommendation

Nebulized hypertonic saline solution

  • RecommendationsThere is not enough evidence to routinely recommend nebulized hypertonic 3% saline solution for acute bronchiolitisEvidence Quality: B; Recommendation Strength: Moderate Recommendation

Deep nasal aspiration

  • RecommendationsA deep airway aspiration is not recommended as it is associated with increased length of stay and mechanical trauma in infantsEvidence Quality: B; Recommendation Strength: Moderate Recommendation

Chest physiotherapy

  • RecommendationsChest physiotherapy as standard clinical practice for hospitalized infants with bronchiolitis cannot be recommendedEvidence Quality: A; Recommendation Strength: Moderate Recommendation

Inhaled bronchodilators

  • RecommendationsClinicians should not administer salbutamol (albuterol) to infants with a diagnosis of bronchiolitis, as salbutamol does not improve O2 saturation, duration of symptoms or length of hospital stay, and there is a potential risk of harm (Evidence Quality: B; Recommendation Strength: Strong Recommendation) [91–96].

Nebulized adrenaline

  • RecommendationsDue to the lack of studies, short duration of action, and potential adverse effects, nebulized adrenaline is not recommendedEvidence Quality: B; Recommendation Strength: Strong Recommendation

Nebulized and systemic steroids

  • RecommendationsUsing nebulized and systemic corticosteroids alone or in combination with other therapies (epinephrine or bronchodilators) in treating acute bronchiolitis is not recommendedEvidence Quality: A; Recommendation Strength: Strong Recommendation

Antibiotics

  • RecommendationsThe use of antibiotics in bronchiolitis is not recommended except in cases with a strong suspicion or clear evidence of a secondary bacterial infectionEvidence Quality: B; Recommendation Strength: Strong Recommendation

Other therapies

  • RecommendationsThe administration of antivirals (ribavirin), montelukast, DNase, inhaled furosemide, inhaled ipratropium bromide, magnesium sulfate, helium, surfactant, and methylxanthine in children with acute bronchiolitis are not supported by the current evidence (Evidence Quality: B; Recommendation Strength: Strong Recommendation) [1, 20–32, 38, 48].

What criteria should be used for safe discharge?

  • RecommendationsExcept for different O2 saturation thresholds recommended for guiding hospital discharge, international guidelines are unanimous on the following criteria for discharge: 1) protracted autonomy from any respiratory support and O2 saturation levels greater than 93% in room air; 2) patient clinically stable; 3) adequate oral intake of fluids and feeds (>75% of usual volume); 4) family unit able in coping, spotting red flag symptoms, monitoring and administrating therapy at home; 5) availability of pediatric health care assistance locally if required (Evidence Quality: B; Recommendation Strength: Strong Recommendation) [1, 20–32, 38, 48].

How can we prevent bronchiolitis?

  • RecommendationsBecause of the lack of effective treatment, reduction of morbidity from RSV and other viral infections causing bronchiolitis must rely on preventive measuresEvidence Quality: B; Recommendation Strength: Strong Recommendation

Abstract

Bronchiolitis is an acute respiratory illness that is the leading cause of hospitalization in young children. This document aims to update the consensus document published in 2014 to provide guidance on the current best practices for managing bronchiolitis in infants. The document addresses care in both hospitals and primary care. The diagnosis of bronchiolitis is based on the clinical history and physical examination. The mainstays of management are largely supportive, consisting of fluid management and respiratory support. Evidence suggests no benefit with the use of salbutamol, glucocorticosteroids and antibiotics with potential risk of harm. Because of the lack of effective treatment, the reduction of morbidity must rely on preventive measures. De-implementation of non-evidence-based interventions is a major goal, and educational interventions for clinicians should be carried out to promote high-value care of infants with bronchiolitis. Well-prepared implementation strategies to standardize care and improve the quality of care are needed to promote adherence to guidelines and discourage non-evidence-based attitudes. In parallel, parents' education will help reduce patient pressure and contribute to inappropriate prescriptions. Infants with pre-existing risk factors (i.e., prematurity, bronchopulmonary dysplasia, congenital heart diseases, immunodeficiency, neuromuscular diseases, cystic fibrosis, Down syndrome) present a significant risk of severe bronchiolitis and should be carefully assessed. This revised document, based on international and national scientific evidence, reinforces the current recommendations and integrates the recent advances for optimal care and prevention of acute bronchiolitis.

Supplementary Information: The online version contains supplementary material available at 10.1186/s13052-022-01392-6.

Contents of the original publication

The section headings of the original.

  • Introduction
  • Methods
  • Eligibility criteria
  • Manuscript review
  • Results
  • How is bronchiolitis diagnosed?
  • What is the role of primary care paediatricians in managing a child with bronchiolitis?
  • Are laboratory (blood an/or urine) tests and radiological exams supported in managing bronchiolitis?
  • When making decision about the hospitalization of an infant with bronchiolitis?
  • When making decision to transfer to intensive care unit an infant with bronchiolitis?
  • Treatment
  • What criteria should be used for safe discharge?
  • How can we prevent bronchiolitis?
  • Long-term consequences of bronchiolitis
  • Conclusions

A question about this guideline?

Medelix answers clinical questions from guidelines and studies – every statement with its source.

Are you the rights holder and object to this reproduction? Write to contact@medelix.ai and we will take the page down promptly. Imprint