Review of 2006 AAP Guidelines on Diagnosis and Management of Bronchiolitis
Posted on October 20th, 2008 No Comments »
RSV season is approaching and it might be worth reviewing the guidelines on diagnosis and management of bronchiolitis. The American Academy of Pediatrics(2006) makes the following recommendations for children 1 month to 2 years of age:
Well-designed randomized controlled trials or diagnostic studies on relevant populations point to the consideration of palivizumab(Synagis) prophylaxis in children with congenital heart disease, chronic lung disease, or prematurity (< 35 weeks of gestation).
Observational studies with consistent findings or limited randomized controlled trials find that we should:
Avoid routine use of
- Antimicrobial meds unless bacterial co-infection is apparent
- Bronchodilators (a careful monitored trial may be useful)
- Chest physiotherapy
- Corticosteroids
- Laboratory testing and radiologic studies for diagnosis
- Ribavirin
Always
- Closely monitor the weaning of supplemental oxygen in infants with a past medical history that includes congenital heart disease, chronic lung disease, or prematurity.
- Consider the use of alcohol-based rubs for hand decontamination.
- Decontaminate hands after patient contact, any contact with inanimate objects in direct patient vicinity, and after glove removal.
- Rely primarily upon history and physical exam to make the diagnosis.
