Review

. 2025 Aug;61(8):1197-1215.

doi: 10.1111/jpc.70144. Epub 2025 Jul 20.

Australasian Bronchiolitis Guideline: 2025 Update

Meredith L Borland^{1

2}, Kate Loveys³, Franz E Babl^{4

5

6}, Elizabeth Cotterell^{7

8}, Libby Haskell^{3

9}, Sharon O'Brien^{1

10

11}, Ed Oakley^{4

5

12}, Catherine L Wilson⁶, Jane Alsweiler³, David Armstrong^{13

14}, Simon S Craig^{6

14

15}, Nigel W Crawford^{16

17

18}, Dianne Crellin^{16

19

20}, Sonja Crone²¹, Trevor Duke^{16

20}, Shane George²², Christine Jeffries-Stokes^{23

24}, Nidhi Krishnan²⁵, Anna Lithgow²⁶, Ken Peacock²⁷, Tomas Ratoni²⁸, Peter Richmond^{29

30}, Annie Smith³¹, Rebecca Starkie³², David Thomas³³, Alexandra Wallace^{3

34}, Michael Zhang³⁵, Emma Tavender^{4

6

36}, Stuart R Dalziel^{3

10

37}; Paediatric Research in Emergency Departments International Collaborative (PREDICT) Network, Australasia

Affiliations

¹ Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.
² Divisions of Paediatrics and Emergency Medicine, School of Medicine, University of Western Australia, Perth, Western Australia, Australia.
³ Department of Paediatrics: Child and Youth Health, School of Medicine, University of Auckland, Auckland, New Zealand.
⁴ Departments of Paediatrics and Critical Care, University of Melbourne, Parkville, Victoria, Australia.
⁵ Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia.
⁶ Emergency Research, Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
⁷ Armidale Rural Referral Hospital, Armidale, New South Wales, Australia.
⁸ School of Rural Medicine and Tablelands Clinical School, University of New England, Armidale, New South Wales, Australia.
⁹ Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.
¹⁰ Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia.
¹¹ Institute for Paediatric Perioperative Excellence, The University of Western Australia, Perth, Western Australia, Australia.
¹² Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
¹³ Department of Respiratory and Sleep Medicine, Monash Children's Hospital, Clayton, Victoria, Australia.
¹⁴ Department of Paediatrics, Monash University, Clayton, Victoria, Australia.
¹⁵ Paediatric Emergency Department, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia.
¹⁶ Royal Children's Hospital, Melbourne, Victoria, Australia.
¹⁷ Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
¹⁸ Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
¹⁹ Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
²⁰ University of Melbourne, Melbourne, Victoria, Australia.
²¹ Department of Paediatrics, Rotorua Hospital, Te Whatu Ora Lakes, Rotorua, New Zealand.
²² Gold Coast University Hospital, Gold Coast, Queensland, Australia.
²³ Rural Clinical School of Western Australia, Kalgoorlie, Western Australia, Australia.
²⁴ Kalgoorlie Regional Hospital, West Australian Country Health Service, Kalgoorlie, Western Australia, Australia.
²⁵ Queensland Children's Hospital, South Brisbane, Queensland, Australia.
²⁶ Department of Paediatrics, The Royal Darwin Hospital, Darwin, Northern Territory, Australia.
²⁷ Department of General Medicine, Children's Hospital at Westmead, Sydney Children's Hospitals Network, Westmead, New South Wales, Australia.
²⁸ Northern NSW Local Health District, New South Wales, Australia.
²⁹ Perth Children's Hospital, Perth, Western Australia, Australia.
³⁰ University of Western Australia, Perth, Western Australia, Australia.
³¹ Southland Hospital, Invercargill, New Zealand.
³² Department of General Practice and Primary Care, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
³³ Department of General Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia.
³⁴ Department of Paediatrics, Waikato Hospital, Te Whatu Ora Waikato Health NZ, Hamilton, New Zealand.
³⁵ Emergency Department, John Hunter Hospital, New Lambton Heights, New South Wales, Australia.
³⁶ Australian Catholic University (ACU), Sydney, New South Wales, Australia.
³⁷ Department of Surgery, School of Medicine, The University of Auckland, Auckland, New Zealand.

PMID: 40685806
PMCID: PMC12397848
DOI: 10.1111/jpc.70144

Review

Australasian Bronchiolitis Guideline: 2025 Update

Meredith L Borland et al. J Paediatr Child Health. 2025 Aug.

. 2025 Aug;61(8):1197-1215.

doi: 10.1111/jpc.70144. Epub 2025 Jul 20.

Authors

Affiliations

¹ Emergency Department, Perth Children's Hospital, Perth, Western Australia, Australia.
² Divisions of Paediatrics and Emergency Medicine, School of Medicine, University of Western Australia, Perth, Western Australia, Australia.
³ Department of Paediatrics: Child and Youth Health, School of Medicine, University of Auckland, Auckland, New Zealand.
⁴ Departments of Paediatrics and Critical Care, University of Melbourne, Parkville, Victoria, Australia.
⁵ Emergency Department, Royal Children's Hospital, Parkville, Victoria, Australia.
⁶ Emergency Research, Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
⁷ Armidale Rural Referral Hospital, Armidale, New South Wales, Australia.
⁸ School of Rural Medicine and Tablelands Clinical School, University of New England, Armidale, New South Wales, Australia.
⁹ Children's Emergency Department, Starship Children's Hospital, Auckland, New Zealand.
¹⁰ Division of Emergency Medicine, Anaesthesia and Pain Medicine, Medical School, University of Western Australia, Perth, Western Australia, Australia.
¹¹ Institute for Paediatric Perioperative Excellence, The University of Western Australia, Perth, Western Australia, Australia.
¹² Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia.
¹³ Department of Respiratory and Sleep Medicine, Monash Children's Hospital, Clayton, Victoria, Australia.
¹⁴ Department of Paediatrics, Monash University, Clayton, Victoria, Australia.
¹⁵ Paediatric Emergency Department, Monash Medical Centre, Monash Health, Clayton, Victoria, Australia.
¹⁶ Royal Children's Hospital, Melbourne, Victoria, Australia.
¹⁷ Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
¹⁸ Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.
¹⁹ Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
²⁰ University of Melbourne, Melbourne, Victoria, Australia.
²¹ Department of Paediatrics, Rotorua Hospital, Te Whatu Ora Lakes, Rotorua, New Zealand.
²² Gold Coast University Hospital, Gold Coast, Queensland, Australia.
²³ Rural Clinical School of Western Australia, Kalgoorlie, Western Australia, Australia.
²⁴ Kalgoorlie Regional Hospital, West Australian Country Health Service, Kalgoorlie, Western Australia, Australia.
²⁵ Queensland Children's Hospital, South Brisbane, Queensland, Australia.
²⁶ Department of Paediatrics, The Royal Darwin Hospital, Darwin, Northern Territory, Australia.
²⁷ Department of General Medicine, Children's Hospital at Westmead, Sydney Children's Hospitals Network, Westmead, New South Wales, Australia.
²⁸ Northern NSW Local Health District, New South Wales, Australia.
²⁹ Perth Children's Hospital, Perth, Western Australia, Australia.
³⁰ University of Western Australia, Perth, Western Australia, Australia.
³¹ Southland Hospital, Invercargill, New Zealand.
³² Department of General Practice and Primary Care, Melbourne Medical School, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Victoria, Australia.
³³ Department of General Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia.
³⁴ Department of Paediatrics, Waikato Hospital, Te Whatu Ora Waikato Health NZ, Hamilton, New Zealand.
³⁵ Emergency Department, John Hunter Hospital, New Lambton Heights, New South Wales, Australia.
³⁶ Australian Catholic University (ACU), Sydney, New South Wales, Australia.
³⁷ Department of Surgery, School of Medicine, The University of Auckland, Auckland, New Zealand.

PMID: 40685806
PMCID: PMC12397848
DOI: 10.1111/jpc.70144

Abstract

Aim: To provide updated evidence-based clinical guidance in the management of infants with bronchiolitis presenting to emergency departments (EDs), general paediatric, or intensive care units (ICUs) in Australia and Aotearoa New Zealand (AoNZ) following the first publication in 2016.

Method: The Paediatric Research in Emergency Departments International Collaborative (PREDICT) network guideline working group appraised, summarised, and updated evidence from 1 January 2000 to 24 January 2024 addressing 41 questions (30 from the 2016 guideline and 11 new questions for 2025). Recommendations were developed using GRADE methodology and revised after a period of external consultation.

Results: The literature search identified 26 467 citations with 431 included in 41 recommendations providing 11 new and 7 key updates. The key changes included: (i) refinement of the clinical features of bronchiolitis, (ii) addition of new risk factors for severity of illness, (iii) advice on the role of biomarkers for unexpected deterioration or admission to ICU, (iv) guidance on glucocorticoids in SARS-CoV-2 co-infection, (v) guidance on combined glucocorticoids/inhaled epinephrine in severe bronchiolitis requiring ICU level care, (vi) refinement of oxygen saturation targets, (vii) guidance on humidified high flow therapy and continuous positive airway pressure, (viii) recommendation on use of RSV prevention therapies/immunisations for babies and mothers.

Conclusion: The updated Australasian Bronchiolitis Guideline provides clinicians across Australasian settings with the latest evidence-based guidance on the management of the commonest condition in infancy requiring hospital admission.

Keywords: bronchiolitis; guideline; management; paediatric; respiratory.

© 2025 The Author(s). Journal of Paediatrics and Child Health published by John Wiley & Sons Australia, Ltd on behalf of Paediatrics and Child Health Division (The Royal Australasian College of Physicians).

PubMed Disclaimer

Conflict of interest statement

D.A., D.C., E.C., N.C., S.C., T.D., S.C., L.H., C.J.S., N.K., A.L., K.L., K.P., T.R., A.S., R.S., D.T., E.T., A.W., C.W., M.Z. have no conflicts of interest to declare. M.L.B., S.R.D., F.E.B., S.O., and E.O.’s institutions have received equipment from Fisher and Paykel Healthcare to support bronchiolitis research. S.R.D. has received funding from Fisher and Paykel Healthcare for travel to an international meeting discussing high flow therapy. P.R.’s institution has received funding for (i) R.S.V. maternal and paediatric vaccination research, (ii) RSV monoclonal antibodies research in infants and high‐risk children, (iii) development of a live commensal bacteria for the prevention of otitis media and viral respiratory infections and (iv) Virtual Lectures to RSV investigators in Merck monoclonal antibody trial (Merck) and Canadian health care workers on RSV prevention (Astra Zeneca). S.G.’s institution has received funding from Fisher and Paykel Healthcare to support bronchiolitis research. J.A.’s institution has received funding for R.S.V. monoclonal antibodies research in infants and high‐risk children. None of the authors receive any personal financial benefits from industry sponsors.

Figures

**FIGURE 1**
PRISMA flow chart. *Source:* Page MJ, et al. BMJ 2021;372:n71. doi: https://doi.org/10.1136/bmj.n71. This work is licensed under CC BY 4.0. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/ .

**FIGURE 2**
Criteria for safe discharge. SpO₂, Peripheral oxygen saturation.

**FIGURE 3**
An evidence‐based approach to the use of respiratory support in infants with bronchiolitis. FiO₂, fractional concentration of inspired oxygen; HF, humidified high flow; nCPAP, nasal continuous positive airway pressure. ¹For otherwise healthy infants aged ≥ 6 weeks: SpO₂ persistently < 90%. For infants aged < 6 weeks, or infants < 12 months with an underlying health condition: SpO₂ persistently < 92%. ²Response to therapy (low‐flow or HF oxygen therapy) is determined by a reduction in respiratory rate, a reduction in heart rate, or a paediatric early warning score within 4–5 h of commencing therapy. ³If at any time, the infant has severe respiratory distress, escalate care. Respiratory distress is a subjective finding. Severe respiratory distress is a level where a senior clinician determines that escalation in care is required, transferring the patient to the emergency department resuscitation area, paediatric ward resuscitation area, high dependency unit, or intensive care unit. Junior staff should escalate concerns regarding severe respiratory distress to senior colleagues.

See this image and copyright information in PMC

References

1. Telfar Barnard L. and Zhang J., The Impact of Respiratory Disease in New Zealand: 2020 Update (Asthma and Respiratory Foundation NZ, 2021).
1. Nazareno A. L., Muscatello D. J., Turner R. M., Wood J. G., Moore H. C., and Newall A. T., “Modelled Estimates of Hospitalisations Attributable to Respiratory Syncytial Virus and Influenza in Australia, 2009‐2017,” Influenza and Other Respiratory Viruses 16, no. 6 (2022): 1082–1090. - PMC - PubMed
1. Dalziel S. R., Haskell L., O'Brien S., et al., “Bronchiolitis,” Lancet 400, no. 10349 (2022): 392–406. - PubMed
1. E. Cotterell, R. Farrugia , “Bronchiolitis,” in Textbook of Pediatric Emergency Medicine, vol. 4, eds. P. Cameron, G. J. Browne , Mitra B., Dalziel S. R., and Craig S. (Elsevier Health Sciences, 2023).
1. O'Brien S., Borland M. L., Cotterell E., et al., “Australasian Bronchiolitis Guideline,” Journal of Paediatrics and Child Health 55, no. 1 (2019): 42–53. - PubMed

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Australasian Bronchiolitis Guideline: 2025 Update

Affiliations

Australasian Bronchiolitis Guideline: 2025 Update

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Miscellaneous