Bronchiolitis in Infants: What Helps, What Doesn’t, and Why
Abstract views: 260
/ 
PDF downloads: 164
DOI:
https://doi.org/10.61705/fvhyrf07Abstract
Bronchiolitis is the most common lower respiratory tract infection in infants and the leading cause of hospitalization in children younger than one year of age. Globally, respiratory syncytial virus (RSV) alone accounts for approximately 33 million episodes of acute lower respiratory tract infection annually in children under five years, with 3 million hospitalizations and over 100,000 deaths worldwide. Despite its substantial burden, decades of research have failed to identify effective pharmacological treatments, and management remains fundamentally supportive. This comprehensive review synthesizes current evidence on bronchiolitis management, emphasizing the critical distinction between interventions with proven benefit and those that, despite widespread historical use, lack efficacy. Evidence strongly supports supportive care consisting of supplemental oxygen for hypoxemia, adequate hydration through oral, nasogastric, or intravenous routes, and gentle nasal suctioning to facilitate feeding. High-flow nasal cannula therapy has emerged as an option for escalating respiratory support. In contrast, robust evidence demonstrates that bronchodilators, corticosteroids, nebulized epinephrine, hypertonic saline in the emergency department, antibiotics, and chest physiotherapy do not improve clinically meaningful outcomes and should not be routinely used. Recent advances in prevention, including nirsevimab and maternal RSV vaccination, represent a paradigm shift in reducing disease burden. The key clinical message is that effective bronchiolitis management requires not just providing supportive care but also avoiding ineffective interventions. In bronchiolitis, less is often more.
Downloads
References
Hasegawa, K., Tsugawa, Y., Brown, D. F., Mansbach, J. M., & Camargo Jr, C. A. (2013). Trends in bronchiolitis hospitalizations in the United States, 2000–2009. Pediatrics, 132(1), 28-36.
Meissner, H. C. (2016). Viral bronchiolitis in children. New England Journal of Medicine, 374(1), 62-72.
Hall, C. B., Weinberg, G. A., Iwane, M. K., Blumkin, A. K., Edwards, K. M., Staat, M. A., ... & Szilagyi, P. (2009). The burden of respiratory syncytial virus infection in young children. New England Journal of Medicine, 360(6), 588-598.
Rose, E. B. (2018). Respiratory syncytial virus seasonality—United States, 2014–2017. MMWR. Morbidity and mortality weekly report, 67.
Stockman, L. J., Curns, A. T., Anderson, L. J., & Fischer-Langley, G. (2012). Respiratory syncytial virus-associated hospitalizations among infants and young children in the United States, 1997–2006. The Pediatric infectious disease journal, 31(1), 5-9.
Rha, B., Curns, A. T., Lively, J. Y., Campbell, A. P., Englund, J. A., Boom, J. A., ... & Gerber, S. I. (2020). Respiratory syncytial virus–associated hospitalizations among young children: 2015–2016. Pediatrics, 146(1), e20193611.
Kirolos, A., Manti, S., Blacow, R., Tse, G., Wilson, T., Lister, M., ... & Campbell, H. (2020). A systematic review of clinical practice guidelines for the diagnosis and management of bronchiolitis. The Journal of infectious diseases, 222(Supplement_7), S672-S679.
Kirolos, A., Manti, S., Blacow, R., Tse, G., Wilson, T., Lister, M., ... & Campbell, H. (2020). A systematic review of clinical practice guidelines for the diagnosis and management of bronchiolitis. The Journal of infectious diseases, 222(Supplement_7), S672-S679.
Li, Y., Wang, X., Blau, D. M., Caballero, M. T., Feikin, D. R., Gill, C. J., ... & Nair, H. (2022). Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than
years in 2019: a systematic analysis. The Lancet, 399(10340), 2047-2064.
Shi, T., McAllister, D. A., O'Brien, K. L., Simoes, E. A., Madhi, S. A., Gessner, B. D., ... & Nair, H. (2017). Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study. The Lancet, 390(10098), 946-958.
Ralston, S. L., Lieberthal, A. S., Meissner, H. C., Alverson, B. K., Baley, J. E., Gadomski, A. M., ... & Hernandez-Cancio, S. (2014). Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics, 134(5), e1474-e1502.
Florin, T. A., Byczkowski, T., Ruddy, R. M., Zorc, J. J., Test, M., & Shah, S. S. (2014). Variation in the management of infants hospitalized for bronchiolitis persists after the 2006 American Academy of Pediatrics bronchiolitis guidelines. The Journal of pediatrics, 165(4), 786-792.
Schuh, S., Babl, F. E., Dalziel, S. R., Freedman, S. B., Macias, C. G., Stephens, D., ... & Pediatric Emergency Research Networks (PERN). (2017). Practice variation in acute bronchiolitis: a pediatric emergency research networks study. Pediatrics, 140(6), e20170842.
Shi, T., Denouel, A., Tietjen, A. K., Campbell, I., Moran, E., Li, X., ... & Nair, H. (2020). Global disease burden estimates of respiratory syncytial virus–associated acute respiratory infection in older adults in 2015: a systematic review and meta-analysis. The Journal of infectious diseases, 222(Supplement_7), S577-S583.
Jartti, T., Smits, H. H., Bønnelykke, K., Bircan, O., Elenius, V., Konradsen, J. R., ... & EAACI Task Force on Clinical Practice Recommendations on Preschool Wheeze. (2019). Bronchiolitis needs a revisit: distinguishing between virus entities and their treatments. Allergy, 74(1), 40-52.
Walsh, E. E., McConnochie, K. M., Long, C. E., & Hall, C. B. (1997). Severity of respiratory syncytial virus infection is related to virus strain. Journal of Infectious Diseases, 175(4), 814-820.
Walsh, E. E., McConnochie, K. M., Long, C. E., & Hall, C. B. (1997). Severity of respiratory syncytial virus infection is related to virus strain. Journal of Infectious Diseases, 175(4), 814-820.
Glezen, W. P., Taber, L. H., Frank, A. L., & Kasel, J. A. (1986). Risk of primary infection and reinfection with respiratory syncytial virus. American journal of diseases of children, 140(6), 543-546.
Midulla, F., Scagnolari, C., Bonci, E., Pierangeli, A., Antonelli, G., De Angelis, D., ... & Moretti, C. (2010). Respiratory syncytial virus, human bocavirus and rhinovirus bronchiolitis in infants. Archives of disease in childhood, 95(1), 35-41.
Jackson, D. J., Gangnon, R. E., Evans, M. D., Roberg, K. A., Anderson, E. L., Pappas, T. E., ... & Lemanske Jr, R. F. (2008). Wheezing rhinovirus illnesses in early life predict asthma development in high-risk children. American journal of respiratory and critical care medicine, 178(7), 667-672.
Williams, J. V., Harris, P. A., Tollefson, S. J., Halburnt-Rush, L. L., Pingsterhaus, J. M., Edwards, K. M., ... & Crowe Jr, J. E. (2004). Human metapneumovirus and lower respiratory tract disease in otherwise healthy infants and children. New England Journal of Medicine, 350(5), 443-450.
Mansbach, J. M., Piedra, P. A., Teach, S. J., Sullivan, A. F., Forgey, T., Clark, S., ... & MARC-30 Investigators. (2012). Prospective multicenter study of viral etiology and hospital length of stay in children with severe bronchiolitis. Archives of pediatrics & adolescent medicine, 166(8), 700-706.
Richard, N., Komurian-Pradel, F., Javouhey, E., Perret, M., Rajoharison, A., Bagnaud, A., ... & Paranhos-Baccalà, G. (2008). The impact of dual viral infection in infants admitted to a pediatric intensive care unit associated with severe bronchiolitis. The Pediatric infectious disease journal, 27(3), 213-217.
Aherne, W., Bird, T., Gardner, P. S., & McQuillin, J. (1970). Pathological changes in virus infections of the lower respiratory tract in children. Journal of clinical pathology, 23(1), 7-18.
Johnson, J. E., Gonzales, R. A., Olson, S. J., Wright, P. F., & Graham, B. S. (2007). The histopathology of fatal untreated human respiratory syncytial virus infection. Modern Pathology, 20(1), 108-119.
McNamara, P. S., & Smyth, R. L. (2002). The pathogenesis of respiratory syncytial virus disease in childhood. British medical bulletin, 61(1), 13-28.
Openshaw, P. J., & Tregoning, J. S. (2005). Immune responses and disease enhancement during respiratory syncytial virus infection. Clinical microbiology reviews, 18(3), 541-555.
Openshaw, P. J., & Tregoning, J. S. (2005). Immune responses and disease enhancement during respiratory syncytial virus infection. Clinical microbiology reviews, 18(3), 541-555.
Hammer, J. (2013). Acute respiratory failure in children. Paediatric respiratory reviews, 14(2), 64-69.
Zorc, J. J., & Hall, C. B. (2010). Bronchiolitis: recent evidence on diagnosis and management. Pediatrics, 125(2), 342-349.
Openshaw, P. J., & Chiu, C. (2013). Protective and dysregulated T cell immunity in RSV infection. Current opinion in virology, 3(4), 468-474.
Hammer, J. (2005). Respiratory mechanics. Paediatric pulmonary function testing, 33, 20-33.
Gaultier, C. (1995). Respiratory muscle function in infants. European Respiratory Journal, 8(1), 150-153.
Bergeson, P. S., & Shaw, J. C. (2001). Are infants really obligatory nasal breathers?. Clinical pediatrics, 40(10), 567-569.
Lambert, L., Sagfors, A. M., Openshaw, P. J., & Culley, F. J. (2014). Immunity to RSV in early-life. Frontiers in immunology, 5, 466.
Peebles Jr, R. S., & Graham, B. S. (2005). Pathogenesis of respiratory syncytial virus infection in the murine model. Proceedings of the American Thoracic Society, 2(2), 110-115.
Menkes, H. A., & Traystman, R. J. (1977). Collateral ventilation. American Review of Respiratory Disease, 116(2), 287-309.
Wright, M., & Piedimonte, G. (2011). Respiratory syncytial virus prevention and therapy: past, present, and future. Pediatric pulmonology, 46(4), 324-347.
Mansbach, J. M., Clark, S., Christopher, N. C., LoVecchio, F., Kunz, S., Acholonu, U., & Camargo Jr, C. A. (2008). Prospective multicenter study of bronchiolitis: predicting safe discharges from the emergency department. Pediatrics, 121(4), 680-688.
Swingler, G. H., Hussey, G. D., & Zwarenstein, M. (2000). Duration of illness in ambulatory children diagnosed with bronchiolitis. Archives of pediatrics & adolescent medicine, 154(10), 997-1000.
Shay, D. K., Holman, R. C., Newman, R. D., Liu, L. L., Stout, J. W., & Anderson, L. J. (1999). Bronchiolitis-associated hospitalizations among US children, 1980-1996. Jama, 282(15), 1440-1446.
Hasegawa, K., Pate, B. M., Mansbach, J. M., Macias, C. G., Fisher, E. S., Piedra, P. A., ... & Camargo Jr, C. A. (2015). Risk factors for requiring intensive care among children admitted to ward with bronchiolitis. Academic pediatrics, 15(1), 77-81.
Øymar, K., Skjerven, H. O., & Mikalsen, I. B. (2014). Acute bronchiolitis in infants, a review. Scandinavian journal of trauma, resuscitation and emergency medicine, 22(1), 23.
Doan, Q., Enarson, P., Kissoon, N., Klassen, T. P., & Johnson, D. W. (2014). Rapid viral diagnosis for acute febrile respiratory illness in children in the Emergency Department. Cochrane Database of Systematic Reviews, (9).
Destino, L., Weisgerber, M. C., Soung, P., Bakalarski, D., Yan, K., Rehborg, R., ... & Simpson, P. (2012). Validity of respiratory scores in bronchiolitis. Hospital pediatrics, 2(4), 202-209.
Destino, L., Weisgerber, M. C., Soung, P., Bakalarski, D., Yan, K., Rehborg, R., ... & Simpson, P. (2012). Validity of respiratory scores in bronchiolitis. Hospital pediatrics, 2(4), 202-209.
Fleming, S., Thompson, M., Stevens, R., Heneghan, C., Plüddemann, A., Maconochie, I., ... & Mant, D. (2011). Normal ranges of heart rate and respiratory rate in children from birth to 18 years of age: a systematic review of observational studies. The Lancet, 377(9770), 1011-1018.
Liu, L. L., Gallaher, M. M., Davis, R. L., Rutter, C. M., Lewis, T. C., & Marcuse, E. K. (2004). Use of a respiratory clinical score among different providers. Pediatric pulmonology, 37(3), 243-248.
Ricci, V., Nunes, V. D., Murphy, M. S., & Cunningham, S. (2015). Bronchiolitis in children: summary of NICE guidance. Bmj, 350.
Schroeder, A. R., Marmor, A. K., Pantell, R. H., & Newman, T. B. (2004). Impact of pulse oximetry and oxygen therapy on length of stay in bronchiolitis hospitalizations. Archives of pediatrics & adolescent medicine, 158(6), 527-530.
Bekhof, J., Reimink, R., & Brand, P. L. (2014). Systematic review: insufficient validation of clinical scores for the assessment of acute dyspnoea in wheezing children. Paediatric respiratory reviews, 15(1), 98-112.
Levine, D. A., Platt, S. L., Dayan, P. S., Macias, C. G., Zorc, J. J., Krief, W., ... & Multicenter RSV-SBI Study Group of the Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. (2004). Risk of serious bacterial infection in young febrile infants with respiratory syncytial virus infections. Pediatrics, 113(6), 1728-1734.
Levine, D. A., Platt, S. L., Dayan, P. S., Macias, C. G., Zorc, J. J., Krief, W., ... & Multicenter RSV-SBI Study Group of the Pediatric Emergency Medicine Collaborative Research Committee of the American Academy of Pediatrics. (2004). Risk of serious bacterial infection in young febrile infants with respiratory syncytial virus infections. Pediatrics, 113(6), 1728-1734.
Jartti, T., Lehtinen, P., Vuorinen, T., & Ruuskanen, O. (2009). Bronchiolitis: age and previous wheezing episodes are linked to viral etiology and atopic characteristics. The Pediatric infectious disease journal, 28(4), 311-317.
Jartti, T., Lehtinen, P., Vuorinen, T., & Ruuskanen, O. (2009). Bronchiolitis: age and previous wheezing episodes are linked to viral etiology and atopic characteristics. The Pediatric infectious disease journal, 28(4), 311-317.
Friedman, J. N., Davis, T., Somaskanthan, A., & Ma, A. (2021). Avoid doing chest x rays in infants with typical bronchiolitis. bmj, 375.
Schuh, S., Lalani, A., Allen, U., Manson, D., Babyn, P., Stephens, D., ... & Dick, P. (2007). Evaluation of the utility of radiography in acute bronchiolitis. The Journal of pediatrics, 150(4), 429-433.
Christakis, D. A., Cowan, C. A., Garrison, M. M., Molteni, R., Marcuse, E., & Zerr, D. M. (2005). Variation in inpatient diagnostic testing and management of bronchiolitis. Pediatrics, 115(4), 878-884.
Schuh, S. (2011). Update on management of bronchiolitis. Current Opinion in Pediatrics, 23(1), 110-114.
Friedman, J. N., Rieder, M. J., Walton, J. M., Canadian Paediatric Society, Acute Care Committee, & Drug Therapy and Hazardous Substances Committee. (2014). Bronchiolitis: recommendations for diagnosis, monitoring and management of children one to 24 months of age. Paediatrics & child health, 19(9), 485-491.
Cunningham, S., Rodriguez, A., Adams, T., Boyd, K. A., Butcher, I., Enderby, B., ... & Lewis, S. C. (2015). Oxygen saturation targets in infants with bronchiolitis (BIDS): a double-blind, randomised, equivalence trial. The Lancet, 386(9998), 1041-1048.
Principi, T., Coates, A. L., Parkin, P. C., Stephens, D., DaSilva, Z., & Schuh, S. (2016). Effect of oxygen desaturations on subsequent medical visits in infants discharged from the emergency department with bronchiolitis. JAMA pediatrics, 170(6), 602-608.
Schuh, S., Freedman, S., Coates, A., Allen, U., Parkin, P. C., Stephens, D., ... & Willan, A. R. (2014). Effect of oximetry on hospitalization in bronchiolitis: a randomized clinical trial. Jama, 312(7), 712-718.
McCulloh, R., Koster, M., Ralston, S., Johnson, M., Hill, V., Koehn, K., ... & Alverson, B. (2015). Use of intermittent vs continuous pulse oximetry for nonhypoxemic infants and young children hospitalized for bronchiolitis: a randomized clinical trial. JAMA pediatrics, 169(10), 898-904.
McCulloh, R., Koster, M., Ralston, S., Johnson, M., Hill, V., Koehn, K., ... & Alverson, B. (2015). Use of intermittent vs continuous pulse oximetry for nonhypoxemic infants and young children hospitalized for bronchiolitis: a randomized clinical trial. JAMA pediatrics, 169(10), 898-904.
Oakley, E., Borland, M., Neutze, J., Acworth, J., Krieser, D., Dalziel, S., ... & Babl, F. E. (2013). Nasogastric hydration versus intravenous hydration for infants with bronchiolitis: a randomised trial. The Lancet Respiratory Medicine, 1(2), 113-120.
Oakley E, Borland M, Neutze J, et al. Nasogastric hydration versus
intravenous hydration for infants with bronchiolitis: a randomised trial. Lancet Respir Med. 2013;1(2):113-120.
Kugelman, A., Raibin, K., Dabbah, H., Chistyakov, I., Srugo, I., Even, L., ... & Riskin, A. (2013). Intravenous fluids versus gastric-tube feeding in hospitalized infants with viral bronchiolitis: a randomized, prospective pilot study. The Journal of Pediatrics, 162(3), 640-642.
Wang, E. E., Law, B. J., & Stephens, D. (1995). Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC) prospective study of risk factors and outcomes in patients hospitalized with respiratory syncytial viral lower respiratory tract infection. The Journal of pediatrics, 126(2), 212-219.
Hanna, S., Tibby, S. M., Durward, A., & Murdoch, I. A. (2003). Incidence of hyponatraemia and hyponatraemic seizures in severe respiratory syncytial virus bronchiolitis. Acta paediatrica, 92(4), 430-434.
Mussman, G. M., Parker, M. W., Statile, A., Sucharew, H., & Brady, P. W. (2013). Suctioning and length of stay in infants hospitalized with bronchiolitis. JAMA pediatrics, 167(5), 414-421.
Postiaux, G., Louis, J., Labasse, H. C., Gerroldt, J., Kotik, A. C., Lemuhot, A., & Patte, C. (2011). Evaluation of an alternative chest physiotherapy method in infants with respiratory syncytial virus bronchiolitis. Respiratory care, 56(7), 989-994.
Yusuf, S., Watson, E. L., Hagan, J. L., & Adekunle-Ojo, A. O. (2024). Comparing nasal suction devices in children with bronchiolitis: A pilot randomized control trial. Journal of Pediatric Nursing, 76, 83-90.
Moschino, L., Mario, F., Carraro, S., Visentin, F., Zanconato, S., & Baraldi, E. (2016). Is nasal suctioning warranted before measuring O2 saturation in infants with bronchiolitis?. Archives of disease in childhood, 101(1), 114-115.
Milési, C., Essouri, S., Pouyau, R., Liet, J. M., Afanetti, M., Portefaix, A., ... & Groupe Francophone de Réanimation et d’Urgences Pédiatriques (GFRUP). (2017). 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 medicine, 43(2), 209-216.
Schibler, A., Pham, T. M. T., Dunster, K. R., Foster, K., Barlow, A., Gibbons, K., & Hough, J. L. (2011). Reduced intubation rates for infants after introduction of high-flow nasal prong oxygen delivery. Intensive care medicine, 37(5), 847-852.
Mayfield, S., Bogossian, F., O'Malley, L., & Schibler, A. (2014). High‐flow nasal cannula oxygen therapy for infants with bronchiolitis: pilot study. Journal of paediatrics and child health, 50(5), 373-378.
Franklin, D., Babl, F. E., Schlapbach, L. J., Oakley, E., Craig, S., Neutze, J., ... & Schibler, A. (2018). A randomized trial of high-flow oxygen therapy in infants with bronchiolitis. New England Journal of Medicine, 378(12), 1121-1131.
Armarego, M., Forde, H., Wills, K., & Beggs, S. A. (2024). High‐flow nasal cannula therapy for infants with bronchiolitis. The Cochrane Database of Systematic Reviews, 2024(3), CD009609.
Kepreotes, E., Whitehead, B., Attia, J., Oldmeadow, C., Collison, A., Searles, A., ... & Mattes, J. (2017). High-flow warm humidified oxygen versus standard low-flow nasal cannula oxygen for moderate bronchiolitis (HFWHO RCT): an open, phase 4, randomised controlled trial. The Lancet, 389(10072), 930-939.
Gadomski, A. M., & Scribani, M. B. (2014). Bronchodilators for bronchiolitis. Cochrane database of systematic reviews, (6).
Hartling, L., Bialy, L. M., Vandermeer, B., Tjosvold, L., Johnson, D. W., Plint, A. C., ... & Fernandes, R. M. (2011). Epinephrine for bronchiolitis. Cochrane Database of Systematic Reviews, (6).
Hartling, L., Fernandes, R. M., Bialy, L., Milne, A., Johnson, D., Plint, A., ... & Vandermeer, B. (2011). Steroids and bronchodilators for acute bronchiolitis in the first two years of life: systematic review and meta-analysis. Bmj, 342.
Wainwright, C., Altamirano, L., Cheney, M., Cheney, J., Barber, S., Price, D., ... & Francis, P. (2003). A multicenter, randomized, double-blind, controlled trial of nebulized epinephrine in infants with acute bronchiolitis. New England Journal of Medicine, 349(1), 27-35.
Skjerven, H. O., Hunderi, J. O. G., Brügmann-Pieper, S. K., Brun, A. C., Engen, H., Eskedal, L., ... & Lødrup Carlsen, K. C. (2013). Racemic adrenaline and inhalation strategies in acute bronchiolitis. New England Journal of Medicine, 368(24), 2286-2293.
Hartling, L., Bialy, L. M., Vandermeer, B., Tjosvold, L., Johnson, D. W., Plint, A. C., ... & Fernandes, R. M. (2011). Epinephrine for bronchiolitis. Cochrane Database of Systematic Reviews, (6).
Zhang, L., Mendoza-Sassi, R. A., Wainwright, C. E., Aregbesola, A., & Klassen, T. P. (2023). Nebulised hypertonic saline solution for acute bronchiolitis in infants. Cochrane database of systematic reviews, (4).
Florin, T. A., Shaw, K. N., Kittick, M., Yakscoe, S., & Zorc, J. J. (2014). Nebulized hypertonic saline for bronchiolitis in the emergency department: a randomized clinical trial. JAMA pediatrics, 168(7), 664-670.
Zhang, L., Mendoza-Sassi, R. A., Wainwright, C. E., Aregbesola, A., & Klassen, T. P. (2023). Nebulised hypertonic saline solution for acute bronchiolitis in infants. Cochrane database of systematic reviews, (4).
Angoulvant, F., Bellêttre, X., Milcent, K., Teglas, J. P., Claudet, I., Le Guen, C. G., ... & Gajdos, V. (2017). Effect of nebulized hypertonic saline treatment in emergency departments on the hospitalization rate for acute bronchiolitis: a randomized clinical trial. JAMA pediatrics, 171(8), e171333-e171333.
Duttweiler, L., Nadal, D., & Frey, B. (2004). Pulmonary and systemic bacterial co-infections in severe RSV bronchiolitis. Archives of disease in childhood, 89(12), 1155-1157.
Smyth, R. L., & Openshaw, P. J. (2006). Bronchiolitis. The lancet, 368(9532), 312-322.
Fernandes, R. M., Bialy, L. M., Vandermeer, B., Tjosvold, L., Plint, A. C., Patel, H., ... & Hartling, L. (2010). Glucocorticoids for acute viral bronchiolitis in infants and young children. Cochrane Database of Systematic Reviews, (10).
Corneli, H. M., Zorc, J. J., Mahajan, P., Shaw, K. N., Holubkov, R., Reeves, S. D., ... & Kuppermann, N. (2007). A multicenter, randomized, controlled trial of dexamethasone for bronchiolitis. New England Journal of Medicine, 357(4), 331-339.
Plint, A. C., Johnson, D. W., Patel, H., Wiebe, N., Correll, R., Brant, R., ... & Klassen, T. P. (2009). Epinephrine and dexamethasone in children with bronchiolitis. New England Journal of Medicine, 360(20), 2079-2089.
Ralston, S., Hill, V., & Waters, A. (2011). Occult serious bacterial infection in infants younger than 60 to 90 days with bronchiolitis: a systematic review. Archives of pediatrics & adolescent medicine, 165(10), 951-956.
Farley, R., Spurling, G. K., Eriksson, L., & Del Mar, C. B. (2014). Antibiotics for bronchiolitis in children under two years of age. Cochrane Database of Systematic Reviews, (10).
Pinto, L. A., Pitrez, P. M., Luisi, F., de Mello, P. P., Gerhardt, M., Ferlini, R., ... & Marostica, P. J. (2012). Azithromycin therapy in hospitalized infants with acute bronchiolitis is not associated with better clinical outcomes: a randomized, double-blinded, and placebo-controlled clinical trial. The Journal of pediatrics, 161(6), 1104-1108.
Roqué-Figuls, M., Gine-Garriga, M., Rugeles, C. G., Perrotta, C., & Vilaro, J. (2023). Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old. Cochrane Database of Systematic Reviews, (4).
Gajdos, V., Katsahian, S., Beydon, N., Abadie, V., De Pontual, L., Larrar, S., ... & Labrune, P. (2010). Effectiveness of chest physiotherapy in infants hospitalized with acute bronchiolitis: a multicenter, randomized, controlled trial. PLoS medicine, 7(9), e1000345.
Mansbach, J. M., Clark, S., Piedra, P. A., Macias, C. G., Schroeder, A. R., Pate, B. M., ... & Zaoutis, L. (2015). Hospital course and discharge criteria for children hospitalized with bronchiolitis. Journal of hospital medicine, 10(4), 205-211.
Willwerth, B. M., Harper, M. B., & Greenes, D. S. (2006). Identifying hospitalized infants who have bronchiolitis and are at high risk for apnea. Annals of emergency medicine, 48(4), 441-447.
Norwood, A., Mansbach, J. M., Clark, S., Waseem, M., & Camargo Jr, C. A. (2010). Prospective multicenter study of bronchiolitis: predictors of an unscheduled visit after discharge from the emergency department. Academic Emergency Medicine, 17(4), 376-382.
Wang, E. E., Law, B. J., & Stephens, D. (1995). Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC) prospective study of risk factors and outcomes in patients hospitalized with respiratory syncytial viral lower respiratory tract infection. The Journal of pediatrics, 126(2), 212-219.
Hall, C. B., Weinberg, G. A., Blumkin, A. K., Edwards, K. M., Staat, M. A., Schultz, A. F., ... & Iwane, M. K. (2013). Respiratory syncytial virus–associated hospitalizations among children less than 24 months of age. Pediatrics, 132(2), e341-e348.
Suh, M., Movva, N., Jiang, X., Bylsma, L. C., Reichert, H., Fryzek, J. P., & Nelson, C. B. (2022). Respiratory syncytial virus is the leading cause of United States infant hospitalizations, 2009–2019: a study of the national (nationwide) inpatient sample. The Journal of infectious diseases, 226(Supplement_2), S154-S163.
Essouri, S., Durand, P., Chevret, L., Balu, L., Devictor, D., Fauroux, B., & Tissières, P. (2011). Optimal level of nasal continuous positive airway pressure in severe viral bronchiolitis. Intensive care medicine, 37(12), 2002-2007.
Mazur, N. I., Higgins, D., Nunes, M. C., Melero, J. A., Langedijk, A. C., Horsley, N., ... & Bont, L. J. (2018). The respiratory syncytial virus vaccine landscape: lessons from the graveyard and promising candidates. The Lancet Infectious Diseases, 18(10), e295-e311.
Committee on Infectious Diseases. (2009). Modified recommendations for use of palivizumab for prevention of respiratory syncytial virus infections. Pediatrics, 124(6), 1694-1701.
Committee on Infectious Diseases and Bronchiolitis Guidelines Committee, Brady, M. T., Byington, C. L., Davies, H. D., Edwards, K. M., Jackson, M. A., ... & Hernández-Cancio, S. (2014). Updated guidance for palivizumab prophylaxis among infants and young children at increased risk of hospitalization for respiratory syncytial virus infection. Pediatrics, 134(2), e620-e638.
Hammitt, L. L., Dagan, R., Yuan, Y., Baca Cots, M., Bosheva, M., Madhi, S. A., ... & Villafana, T. (2022). Nirsevimab for prevention of RSV in healthy late-preterm and term infants. New England Journal of Medicine, 386(9), 837-846.
Griffin, M. P., Yuan, Y., Takas, T., Domachowske, J. B., Madhi, S. A., Manzoni, P., ... & DeVincenzo, J. P. (2020). Single-dose nirsevimab for prevention of RSV in preterm infants. New England Journal of Medicine, 383(5), 415-425.
Domachowske, J., Madhi, S. A., Simões, E. A., Atanasova, V., Cabañas, F., Furuno, K., ... & Villafana, T. (2022). Safety of nirsevimab for RSV in infants with heart or lung disease or prematurity. New England Journal of Medicine, 386(9), 892-894.
Jones, J. M. (2023). Use of nirsevimab for the prevention of respiratory syncytial virus disease among infants and young children: recommendations of the Advisory Committee on Immunization Practices—United States, 2023. MMWR. Morbidity and mortality weekly report, 72.
Moline, H. L. (2024). Early estimate of nirsevimab effectiveness for prevention of respiratory syncytial virus–associated hospitalization among infants entering their first respiratory syncytial virus season—new vaccine surveillance network, October 2023–February 2024. MMWR. Morbidity and mortality weekly report, 73.
Kampmann, B., Madhi, S. A., Munjal, I., Simões, E. A., Pahud, B. A., Llapur, C., ... & Gurtman, A. (2023). Bivalent prefusion F vaccine in pregnancy to prevent RSV illness in infants. New England Journal of Medicine, 388(16), 1451-1464.
Fleming-Dutra, K. E. (2023). Use of the Pfizer respiratory syncytial virus vaccine during pregnancy for the prevention of respiratory syncytial virus–associated lower respiratory tract disease in infants: recommendations of the Advisory Committee on Immunization Practices—United States, 2023. MMWR. Morbidity and mortality weekly report, 72.
French, C. E., McKenzie, B. C., Coope, C., Rajanaidu, S., Paranthaman, K., Pebody, R., ... & Beck, C. R. (2016). Risk of nosocomial respiratory syncytial virus infection and effectiveness of control measures to prevent transmission events: a systematic review. Influenza and other respiratory viruses, 10(4), 268-290.
Bradley, J. P., Bacharier, L. B., Bonfiglio, J., Schechtman, K. B., Strunk, R., Storch, G., & Castro, M. (2005). Severity of respiratory syncytial virus bronchiolitis is affected by cigarette smoke exposure and atopy. Pediatrics, 115(1), e7-e14.
Lanari, M., Prinelli, F., Adorni, F., Di Santo, S., Faldella, G., Silvestri, M., & Musicco, M. (2013). Maternal milk protects infants against bronchiolitis during the first year of life. Results from an Italian cohort of newborns. Early human development, 89, S51-S57.
Parikh, K., Hall, M., & Teach, S. J. (2014). Bronchiolitis management before and after the AAP guidelines. Pediatrics, 133(1), e1-e7.
Doan, Q., Enarson, P., Kissoon, N., Klassen, T. P., & Johnson, D. W. (2014). Rapid viral diagnosis for acute febrile respiratory illness in children in the Emergency Department. Cochrane Database of Systematic Reviews, (9).
Hróbjartsson, A., & Gøtzsche, P. C. (2004). Placebo interventions for all clinical conditions. Cochrane database of systematic reviews, (2).
Maguire, S., Ranmal, R., Komulainen, S., Pearse, S., Maconochie, I., Lakhanpaul, M., ... & Stephenson, T. (2011). Which urgent care services do febrile children use and why?. Archives of disease in childhood, 96(9), 810-816.
Ralston, S. L., Garber, M. D., Rice-Conboy, E., Mussman, G. M., Shadman, K. A., Walley, S. C., ... & Value in Inpatient Pediatrics Network Quality Collaborative for Improving Hospital Compliance with the AAP Bronchiolitis Guideline (BQIP). (2016). A multicenter collaborative to reduce unnecessary care in inpatient bronchiolitis. Pediatrics, 137(1), e20150851.
Mittal, V., Hall, M., Morse, R., Wilson, K. M., Mussman, G., Hain, P., ... & Shah, S. S. (2014). Impact of inpatient bronchiolitis clinical practice guideline implementation on testing and treatment. The Journal of Pediatrics, 165(3), 570-576.
Wisely, C. (2013). Society of Hospital Medicine–Pediatric Hospital Medicine: five things physicians and patients should question.
Hall, C. B., Long, C. E., & Schnabel, K. C. (2001). Respiratory syncytial virus infections in previously healthy working adults. Clinical infectious diseases, 33(6), 792-796.
Manti, S., Staiano, A., Orfeo, L., Midulla, F., Marseglia, G. L., Ghizzi, C., ... & Baraldi, E. (2023). UPDATE-2022 Italian guidelines on the management of bronchiolitis in infants. Italian journal of pediatrics, 49(1), 19.
Boyce, T. G., Mellen, B. G., Mitchel Jr, E. F., Wright, P. F., & Griffin, M. R. (2000). Rates of hospitalization for respiratory syncytial virus infection among children in medicaid. The Journal of pediatrics, 137(6), 865-870.
Schroeder, A. R., Mansbach, J. M., Stevenson, M., Macias, C. G., Fisher, E. S., Barcega, B., ... & Camargo Jr, C. A. (2013). Apnea in children hospitalized with bronchiolitis. Pediatrics, 132(5), e1194-e1201.
Martinez, F. D., Wright, A. L., Taussig, L. M., Holberg, C. J., Halonen, M., Morgan, W. J., & Group Health Medical Associates. (1995). Asthma and wheezing in the first six years of life. New England Journal of Medicine, 332(3), 133-138.
Additional Files
Published
Issue
Section
License
Copyright (c) 2026 International Journal of Medical Research
This work is licensed under a Creative Commons Attribution 4.0 International License.
All papers should be submitted electronically. All submitted manuscripts must be original work that is not under submission at another journal or under consideration for publication in another form, such as a monograph or chapter of a book. Authors of submitted papers are obligated not to submit their paper for publication elsewhere until an editorial decision is rendered on their submission. Further, authors of accepted papers are prohibited from publishing the results in other publications that appear before the paper is published in the Journal unless they receive approval for doing so from the Editor-In-Chief.
IJMR open access articles are licensed under a Creative Commons Attribution-ShareAlike 4.0 International License. This license lets the audience to give appropriate credit, provide a link to the license, and indicate if changes were made and if they remix, transform, or build upon the material, they must distribute contributions under the same license as the original.
