Bronchiolitis

• Specific evidence is summarized in Table 1. • Based on strong research evidence, bronchiolitis is a clinical diagnosis and, therefore, clinicians should not routinely use chest radiography or laboratory tests to evaluate. (1) • Based on some research as well as consensus, (1) clinicians may choose not to use continuous pulse oximetry to monitor hospitalized patients with bronchiolitis and may choose to provide only supplemental oxygen therapy for oxygen saturations less than 90%. (23)(24) • Based on strong research evidence, treatment of bronchiolitis should not routinely include the use of bronchodilators, corticosteroids, or antibiotics. (1)(31)(32) Although there has been early conflicting evidence on the utility of nebulized hypertonic saline, more recent analyses, particularly in US populations, lean toward recommending against its use for routine treatment of bronchiolitis. (40)(43) • Based on strong research evidence, as well as some consensus, clinicians should educate and counsel families about bronchiolitis and ways to minimize risk, including proper hand hygiene, decreasing tobacco smoke exposure, and encouraging breastfeeding. (1) • Strong research evidence supports that clinicians should use palivizumab prophylaxis in specific populations based on specific annual recommendations. (50) • Based on some research evidence, clinicians could consider using clinical pathways incorporating American Academy of Pediatrics clinical practice guidelines to help minimize variation of care, improve outcomes for patients, and prevent overuse of therapies not routinely recommended. (53)(54)(55)(56) • Overall prognosis for infants and children with bronchiolitis is good because it is a self-limited illness. (1) Based on some research evidence and consensus, given the association with potential for future risk of wheezing and development of asthma, providers and caregivers should remain vigilant for future signs and symptoms consistent with asthma. (57)(58).