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. 2024 Dec;96(7):1560-1567.
doi: 10.1038/s41390-024-03340-y. Epub 2024 Jun 20.

Bronchiolitis: evidence-based management in high-risk infants in the intensive care setting

Ruth Walsh  1 , Liam Costello  2 , Alexandria DiCosimo  2 , Anne-Marie Doyle  2 , Laura Kehoe  2 , Cormac Mulhall  2 , Sean O'Hara  2 , Basil Elnazir  2   3 , Judith Meehan  2   4 , Eman Isweisi  2   4 , Gergana Semova  2   4 , Aoife Branagan  2   4   5 , Edna Roche  2   4   6 , Eleanor Molloy  2   4   5   7   8
Affiliations

Bronchiolitis: evidence-based management in high-risk infants in the intensive care setting

Ruth Walsh et al. Pediatr Res. 2024 Dec.

Abstract

Aim: Systematically review the management of infants with severe bronchiolitis in a paediatric intensive care unit (PICU) setting with a focus on high-risk infants to identify gaps in evidence-based knowledge.

Methods: This systematic review utilised Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) to examine the literature on the PICU management of bronchiolitis in infants <24 months old. Three databases, Embase, PubMed and Medline, were searched and higher levels of evidence I, II and III were included.

Results: There were 455 papers reviewed and 26 met the inclusion criteria. Furthermore, 19 of these studied respiratory interventions such as positive airway pressure and oxygen delivery. The remaining 7 examined: erythropoietin, caffeine, dexamethasone, protein supplementation, ribavirin, respiratory syncytial virus immune globulin, or diuretic therapy. Of the 26 studies, 20 excluded infants with high-risk conditions. Therapies showing favourable outcomes included Heliox, prophylactic dexamethasone pre-extubation, protein supplementation, and diuretic use.

Conclusions: Clinical trials for bronchiolitis management frequently exclude high-risk children. Innovative study design in the future may improve access to clinical trials for the management of bronchiolitis in high-risk infants in a PICU setting.

Impact: Clinical trials for bronchiolitis management frequently exclude high-risk children. We review the evidence base for the management of an under-investigated patient demographic in the setting of acute bronchiolitis. Randomised controlled trials are needed to determine the efficacy of management strategies for bronchiolitis in high-risk infants in a paediatric intensive care setting.

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Conflict of interest statement

Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1. PRISMA flow diagram of study selection process.
ICU Intensive Care Unit.
See this image and copyright information in PMC

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References

    1. Ghazaly, M. & Nadel, S. Characteristics of children admitted to intensive care with acute bronchiolitis. Eur. J. Pediatr.177, 913–920 (2018). - PMC - PubMed
    1. McConnochie, K. M., Hall, C. B., Walsh, E. E. & Roghmann, K. J. Variation in severity of respiratory syncytial virus infections with subtype. J. Pediatr.117, 52–62 (1990). - PubMed
    1. Meissner, H. C. Viral bronchiolitis in children. N. Engl. J. Med.374, 62–72 (2016). - PubMed
    1. Hall, C. B. et al. The burden of respiratory syncytial virus infection in young children. N. Engl. J. Med. 360, 588–598 (2009). - PMC - PubMed
    1. Hasegawa, K., Tsugawa, Y., Brown, D. F. M., Mansbach, J. M. & Camargo, C. A. Trends in bronchiolitis hospitalizations in the United States, 2000–2009. Pediatrics132, 28–36 (2013). - PMC - PubMed

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