Bronchiolitis

Evidence repositories are collections of best available resources and evidence (clinical guidelines, peer reviewed literature, systematic reviews, etc.), collated by our knowledge synthesis team and content advisors. This evidence repository is not intended to be an exhaustive list of resources for a topic, but rather a curated list of current, evidence-based resources, based on expert consensus of relevance and usability for a general emergency department setting. We search databases (Cochrane Library, PubMed, TRIP Database) and web search engines (Google, Google Scholar) to locate evidence. Additionally, hospital websites are browsed for guidance documents, such as clinical practice guidelines (CPG) for healthcare professionals.

Every effort is made to identify resources that are open access (i.e. publicly available, free of charge, not requiring a subscription).

More information about the creation of our evidence repositories can be found at https://pubmed.ncbi.nlm.nih.gov/28537762/

Thank you to the following content experts and Knowledge Synthesis team who led the development of this

Amy Plint, MD, Emergency Pediatrician, Children’s Hospital of Eastern Ontario (CHEO); Senior Scientist, CHEO Research Institute; Professor, Department of Pediatrics and Department of Emergency Medicine; Tier I Research Chair in Pediatric Emergency Medicine, University of Ottawa

Gabrielle Freire, MDCM, FRCPC, MHSc, Paediatric Emergency Medicine Physician; Assistant Professor of Paediatrics, The Hospital for Sick Children, University of Toronto

Liza Bialy, Knowledge Synthesis Project Coordinator, Alberta Research Centre for Health Evidence, Department of Pediatrics, University of Alberta

TREKK developed resources for healthcare providers and parents & families can be found here.

1. O’Brien S, Borland ML, Cotterell E, Armstrong D, Babl F, Bauert P, et al. Australasian bronchiolitis guideline. Journal of Paediatrics and Child Health. 2019;55(1):42-53.
2. NICE Guideline (NG9). Clinical Guideline: Bronchiolitis in children: diagnosis and management. 2015.
3. Canadian Paediatric Society. Bronchiolitis: Recommendations for diagnosis, monitoring and management of children one to 24 months of age. 2014.
4. Ralston SL, Lieberthal AS, Meissner HC, Alverson BK, Baley JE, Gadomski AM, et al. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. American Academy of Ped. 2014.

1. Dalziel SR, Haskell L, O’Brien S, Borland ML, Plint AC, Babl FE, et al. Bronchiolitis. Lancet. 2022;400(10349):392-406.
2. Bialy L, Foisy M, Smith M, Fernandes RM. The Cochrane Library and the treatment of bronchiolitis in children: an overview  of reviews. Evidence-Based Child Health: A Cochrane Review Journal. 2011;6(1):258-75.

1. Pereira RA, Oliveira de Almeida V, Zambrano M, Zhang L, Amantéa SL. Effects of nebulized epinephrine in association with hypertonic saline for infants with acute bronchiolitis: A systematic review and meta-analysis. Health Sci Rep. 2022;5(3):e598.
2. Lin J, Zhang Y, Song A, Ying L, Dai J. Exploring the appropriate dose of nebulized hypertonic saline for bronchiolitis: a  dose-response meta-analysis. J Investig Med. 2022;70(1):46-54.
3. Kuitunen I, Kiviranta P, Sankilampi U, Salmi H, Renko M. Helium-oxygen in bronchiolitis-A systematic review and meta-analysis. Pediatr Pulmonol. 2022;57(6):1380-91.
4. Jat KR, Dsouza JM, Mathew JL. Continuous positive airway pressure (CPAP) for acute bronchiolitis in children. Cochrane  Database Syst Rev. 2022;4(4):Cd010473.
5. Elliott SA, Gaudet LA, Fernandes RM, Vandermeer B, Freedman SB, Johnson DW, et al. Comparative efficacy of  bronchiolitis interventions in acute care: a network meta-analysis. Pediatrics. 2021;147(5).
6. Cai Z, Lin Y, Liang J. Efficacy of salbutamol in the treatment of infants with bronchiolitis: A meta-analysis of 13 studies.  Medicine (Baltimore). 2020;99(4):e18657.
7. O’Brien S, Craig S, Babl FE, Borland ML, Oakley E, Dalziel SR. Rational use of high-flow therapy in infants with  bronchiolitis. What do the latest trials tell us? A Paediatric Research in Emergency Departments International Collaborative perspective. J Paediatr Child Health. 2019;55(7):746-52.
8. McDaniel CE, Ralston S, Lucas B, Schroeder AR. Association of diagnostic criteria with urinary tract infection prevalence in bronchiolitis: a systematic review and meta-analysis. JAMA Pediatr. 2019;173(3):269-77.
9. Lin J, Zhang Y, Xiong L, Liu S, Gong C, Dai J. High-flow nasal cannula therapy for children with bronchiolitis: a systematic review and meta-analysis. Arch Dis Child. 2019;104(6):564-76.
10. Zhang L, Mendoza‐Sassi RA, Wainwright C, Klassen TP. Nebulised hypertonic saline solution for acute bronchiolitis in infants. Cochrane Database of Systematic Reviews. 2017.
11. Farley R, Spurling GKP, Eriksson L, Del Mar CB. Antibiotics for bronchiolitis in children under two years of age. Cochrane Database of Systematic Reviews. 2014.
12. Fernandes RM, Bialy LM, Vandermeer B, Tjosvold L, Plint AC, Patel H, et al. Glucocorticoids for acute viral bronchiolitis in infants and young children. Cochrane Database of Systematic Reviews. 2013.

1. Eşki A, Öztürk GK, Turan C, Özgül S, Gülen F, Demir E. High-flow nasal cannula oxygen in children with bronchiolitis: A randomized controlled trial. Pediatr Pulmonol. 2022;57(6):1527-34.
2. Durand P, Guiddir T, Kyheng C, Blanc F, Vignaud O, Epaud R, et al. A randomised trial of high-flow nasal cannula in infants with moderate bronchiolitis. Eur Respir J. 2020;56(1).
3. Wrotek A, Czajkowska M, Jackowska T. Chest radiography in children hospitalized with bronchiolitis. Adv Exp Med Biol. 2019;1222:55-62.
4. Seliem W, Sultan AM. Does heliox administered by low-flow nasal cannula improve respiratory distress in infants with respiratory syncytial virus acute bronchiolitis? A randomized controlled trial. An Pediatr (Engl Ed). 2019;90(1):3-9.
5. Flores-González JC, Valladares CM, Yun Castilla C, Mayordomo-Colunga J, Quesada SP, Martín Delgado CM, et al. Association of fluid overload with clinical outcomes in critically ill children with bronchiolitis: bronquiolitis en la unidad de cuidados intensivos pediátricos (BRUCIP) study. Pediatr Crit Care Med. 2019;20(3):e130-e6.
6. Schuh S, Kwong JC, Holder L, Graves E, Macdonald EM, Finkelstein Y. Predictors of critical care and mortality in bronchiolitis after emergency department discharge. J Pediatr. 2018;199:217-22.e1.
7. Freire G, Kuppermann N, Zemek R, Plint AC, Babl FE, Dalziel SR, et al. Predicting escalated care in infants with bronchiolitis. Pediatrics. 2018;142(3).
8. Franklin D, Babl FE, Schlapbach LJ, Oakley E, Craig S, Neutze J, et al. A randomized trial of high-flow oxygen therapy in infants with bronchiolitis. New England Journal of Medicine. 2018;378(12):1121-31.
9. Biagi C, Pierantoni L, Baldazzi M, Greco L, Dormi A, Dondi A, et al. Lung ultrasound for the diagnosis of pneumonia in children with acute bronchiolitis. BMC Pulm Med. 2018;18(1):191.
10. Milési C, Essouri S, Pouyau R, Liet JM, Afanetti M, Portefaix A, et al. High flow nasal cannula (HFNC) versus nasal continuous positive airway pressure (nCPAP) for the initial respiratory management of acute viral bronchiolitis in young infants: a multicenter randomized controlled trial (TRAMONTANE study). Intensive Care Med. 2017;43(2):209-16.
11. Kepreotes E, Whitehead B, Attia J, Oldmeadow C, Collison A, Searles A, et al. High-flow warm humidified oxygen versus standard low-flow nasal cannula oxygen for moderate bronchiolitis (HFWHO RCT): an open, phase 4, randomised controlled trial. Lancet. 2017;389(10072):930-9.
12. Angoulvant F, Bellêttre X, Milcent K, Teglas JP, Claudet I, Le Guen CG, et al. Effect of nebulized hypertonic saline treatment in emergency departments on the hospitalization rate for acute bronchiolitis: a randomized clinical trial. JAMA Pediatr. 2017;171(8):e171333.
13. Schreiber S, Ronfani L, Ghirardo S, Minen F, Taddio A, Jaber M, et al. Nasal irrigation with saline solution significantly improves oxygen saturation in infants with bronchiolitis. Acta Paediatr. 2016;105(3):292-6.
14. Principi T, Coates AL, Parkin PC, Stephens D, DaSilva Z, Schuh S. Effect of oxygen desaturations on subsequent medical visits in infants discharged from the emergency department with bronchiolitis. JAMA Pediatr. 2016;170(6):602-8.
15. McCulloh R, Koster M, Ralston S, Johnson M, Hill V, Koehn K, et al. Use of intermittent vs continuous pulse oximetry for nonhypoxemic infants and young children hospitalized for bronchiolitis: a randomized clinical trial. JAMA Pediatr. 2015;169(10):898-904.
16. Khanal A, Sharma A, Basnet S, Sharma PR, Gami FC. Nebulised hypertonic saline (3%) among children with mild to moderately severe bronchiolitis–a double blind randomized controlled trial. BMC Pediatr. 2015;15:115.
17. Flores-González JC, Matamala-Morillo MA, Rodríguez-Campoy P, Pérez-Guerrero JJ, Serrano-Moyano B, Comino-Vazquez P, et al. Epinephrine improves the efficacy of nebulized hypertonic saline in moderate bronchiolitis: a randomised clinical trial. PLoS One. 2015;10(11):e0142847.
18. Cunningham S, Rodriguez A, Boyd KA, McIntosh E, Lewis SC. Bronchiolitis of Infancy Discharge Study (BIDS): a multicentre, parallel-group, double-blind, randomised controlled, equivalence trial with economic evaluation. Health Technol Assess. 2015;19(71):i-xxiii, 1-172.
19. Schuh S, Freedman S, Coates A, Allen U, Parkin PC, Stephens D, et al. Effect of oximetry on hospitalization in bronchiolitis: a randomized clinical trial. JAMA. 2014;312(7):712-8.
20. Oakley E, Borland M, Neutze J, Acworth J, Krieser D, Dalziel S, et al. Nasogastric hydration versus intravenous hydration for infants with bronchiolitis: a randomised trial. Lancet Respir Med. 2013;1(2):113- 20.
21. Yong JH, Schuh S, Rashidi R, Vanderby S, Lau R, Laporte A, et al. A cost effectiveness analysis of omitting radiography in diagnosis of acute bronchiolitis. Pediatr Pulmonol. 2009;44(2):122-7.
22. Plint AC, Johnson DW, Patel H, Wiebe N, Correll R, Brant R, et al. Epinephrine and dexamethasone in children with bronchiolitis. N Engl J Med. 2009;360(20):2079-89.
23. Schuh S, Lalani A, Allen U, Manson D, Babyn P, Stephens D, et al. Evaluation of the utility of radiography in acute bronchiolitis. J Pediatr. 2007;150(4):429-33.
24. Corneli HM, Zorc JJ, Mahajan P, Shaw KN, Holubkov R, Reeves SD, et al. A multicenter, randomized, controlled trial of dexamethasone for bronchiolitis. N Engl J Med. 2007;357(4):331-9.