No, Prednisolone Should NOT Be Used for Pediatric Bronchiolitis
The American Academy of Pediatrics explicitly recommends against routine corticosteroid use in bronchiolitis management, as robust evidence from multiple randomized controlled trials demonstrates no clinically meaningful benefit for any outcome. 1
Why Corticosteroids Don't Work
The evidence against corticosteroids is definitive and consistent:
A Cochrane meta-analysis of 13 randomized controlled trials involving 1,198 infants found no statistically significant benefits from systemic glucocorticoids compared to placebo for any clinically meaningful outcome. 1
Corticosteroids showed no improvements in:
Inhaled corticosteroids also showed no benefit in the acute phase of bronchiolitis, and their safety profile in infants remains unclear. 1
The Harm-Benefit Analysis
The benefits-harms assessment shows a preponderance of harm over benefit. 1
The harm is exposure to unnecessary medication with potential adverse effects without any demonstrated clinical benefit. 1
The aggregate evidence quality is rated as B (randomized clinical trials with limitations), with minimal to no benefit demonstrated. 1
What About Special Populations?
Even in subgroups where clinicians might be tempted to use corticosteroids, the evidence remains negative:
For infants who later develop asthma: A 2017 study of 2,479 children with bronchiolitis who were later hospitalized for asthma found that corticosteroid prescription during the initial bronchiolitis admission was NOT associated with shorter length of stay in multivariate analysis. 2
For severely ill patients requiring mechanical ventilation: Systematic reviews conclude that systemic corticosteroids have no benefit even for patients with mechanical ventilation. 3
The Clinical Reality vs. Evidence Gap
Despite up to 60% of hospitalized infants receiving corticosteroid therapy in practice, this represents overtreatment not supported by evidence. 1
This widespread use persists despite consistent findings across multiple systematic reviews and meta-analyses showing no benefit. 1, 4, 5
What TO Do Instead: Evidence-Based Supportive Care
The mainstay of bronchiolitis management is supportive care only: 1
Oxygen supplementation: Only if SpO₂ persistently falls below 90%, maintaining SpO₂ ≥90% 1, 6, 7
Hydration management: Assess hydration status and ability to take fluids orally, with IV fluids (isotonic) reserved only for infants unable to maintain adequate oral intake 1, 6
Airway clearance: Gentle nasal suctioning as needed for symptomatic relief (avoid deep suctioning) 6
Breastfeeding continuation: If possible, as it reduces hospitalization risk by 72% 1, 6
Critical Pitfall to Avoid
Do not prescribe corticosteroids based on clinical intuition, family history of atopy, or eczema. Even when risk factors for asthma are present, corticosteroids do not improve outcomes in bronchiolitis. 2 The routine use of bronchodilators, epinephrine, or corticosteroids in the absence of demonstrated clinical benefits for individual patients is not justified. 5