From the Guidelines
Bronchiolitis treatment in pediatric patients primarily involves supportive care rather than medications, focusing on ensuring adequate hydration, nasal suctioning, and monitoring oxygen saturation with supplemental oxygen provided if levels fall below 90-92% 1. The mainstay of treatment includes:
- Ensuring adequate hydration through oral or IV fluids
- Nasal suctioning to clear secretions
- Monitoring oxygen saturation with supplemental oxygen provided if levels fall below 90-92% Most cases can be managed at home with careful monitoring, nasal suctioning, and adequate fluid intake. Medications such as bronchodilators (albuterol), corticosteroids 1, and antibiotics are generally not recommended as they have not shown significant benefit in bronchiolitis and may cause side effects. Nebulized hypertonic saline (3%) may be considered in hospitalized infants with prolonged symptoms. Hospital admission is indicated for infants with respiratory distress, oxygen saturation below 90%, dehydration, or apnea. In severe cases requiring intensive care, high-flow nasal cannula oxygen or mechanical ventilation may be necessary. Bronchiolitis is typically caused by respiratory syncytial virus (RSV) and is self-limiting, with most children improving within 1-2 weeks, though cough may persist for several weeks. Prevention strategies include hand hygiene, avoiding exposure to sick contacts, and for high-risk infants (premature, with heart/lung disease), palivizumab prophylaxis may be considered during RSV season, while ribavirin should not be used routinely in children with bronchiolitis 1.
From the FDA Drug Label
VIRAZOLE® (Ribavirin for Inhalation Solution, USP) is indicated for the treatment of hospitalized infants and young children with severe lower respiratory tract infections due to RSV. Treatment early in the course of severe lower respiratory tract infection may be necessary to achieve efficacy. Only severe RSV lower respiratory tract infection should be treated with VIRAZOLE The treatment for bronchiolitis in pediatrics due to RSV is ribavirin (VIRAZOLE) inhalation solution, but only for severe cases requiring hospitalization 2.
- Indications: Severe lower respiratory tract infections due to RSV in hospitalized infants and young children.
- Key considerations: Treatment should be based on the severity of the RSV infection and the presence of underlying conditions.
- Important note: The vast majority of infants and children with RSV infection have mild, self-limited disease that does not require hospitalization or antiviral treatment.
From the Research
Treatment for Bronchiolitis in Pediatrics
The treatment for bronchiolitis in pediatrics primarily focuses on supportive care, as there is no specific treatment for viral bronchiolitis 3, 4. The mainstay of therapy consists of:
- Nasal suctioning
- Nebulized 3% hypertonic saline
- Assisted feeding and hydration
- Humidified O2 delivery
Recommended Therapies
Recommended therapies for bronchiolitis include:
- Intravenous or nasogastric hydration and nutritional support
- Supplemental oxygen
- Respiratory support 3
- Enteral tube fluid therapy, which likely results in little to no difference in length of hospital stay compared with the IV fluid group, but may reduce local complications and increase the success of insertion of fluid modality at first attempt 5
Non-Recommended Therapies
Non-recommended therapies for bronchiolitis include:
- Routine use of chest radiographs
- Viral testing or laboratory evaluation
- Routine administration of bronchodilators, including albuterol and nebulized epinephrine
- Corticosteroids
- Hypertonic saline for routine use 3, 4
- Antibiotics or antivirals, unless there is a secondary bacterial infection 4
High-Risk Patients
High-risk patients, such as those with pre-existing risk factors like prematurity, bronchopulmonary dysplasia, congenital heart diseases, and immunodeficiency, may require more intensive care and monitoring 6, 4.