Linee guida
Le nuove Linee Guida sulla bronchiolite
New bronchiolitis guidelines
Giorgio Cozzi1, Sara Pusceddu2, Lorenzo Mambelli2, Egidio Barbi3, Federico Marchetti2
1IRCCS Materno-Infantile “Burlo Garofolo”, Trieste
2UOC di Pediatria e Neonatologia, Ospedale di Ravenna, AUSL della Romagna
3SC di Pediatria d’Urgenza e Pronto Soccorso Pediatrico, IRCCS Materno-Infantile “Burlo Garofolo”, Trieste
Giugno 2015 - pagg. 369 -375
Abstract
Bronchiolitis is the leading cause of lower respiratory tract infection and hospitalization
in children less than 1 year old. The American Academy of Pediatrics (AAP) and the Italian
Pediatric Society (SIP) have recently published new guidelines for the diagnosis,
management and prevention of bronchiolitis. Indications in the two documents are similar,
but bronchiolitis management is still debated. In particular pharmacological treatments
are not supported by enough evidence, whereas support therapy with oxygen, hydration
and nutrition seems the only useful option. The aim of the present work is to summarise
these new guidelines, adding a brief comment to each recommendation, in order
to produce a useful and practical everyday guide for the paediatrician.
Classificazione MeSH
Bibliografia
1. Ralston SL, Lieberthal AS, Meissner HC,
et al. American Academy of Pediatrics. Clinical
practice guideline: the diagnosis, management,
and prevention of bronchiolitis. Pediatrics
2014;134(5):e1474-502.
2. Baraldi E, Lanari M, Manzoni P, et al. Inter-
society consensus document on treatment
and prevention of bronchiolitis in newborns
and infants. Ital J Pediatr 2014;40:65.
3. Levine DA, Platt SL, Dayan PS, et al.; RSVSBI
Study Group of the Pediatric Emergency
Medicine Collaborative Research Committee
of the American Academy of Pediatrics. Risk
of serious bacterial infection in young febrile
infants with respiratory syncytial virus infections.
Pediatrics 2004;113(6):1728-34.
4. Librizzi J, McCulloh R, Koehn K, Alverson
B. Appropriateness of testing for serious bacterial
infection in children hospitalized with
bronchiolitis. Hosp Pediatr 2014;4(1):33-8.
5. Gadomski AM, Scribani MB. Bronchodilators
for bronchiolitis. Cochrane Database Syst
Rev 2014;6:CD001266.
6. Plint AC, Johnson DW, Patel H, et al. Epinephrine
and dexamethasone in children
with bronchiolitis. N Engl J Med 2009;360
(20):2079-89.
7. Wainwright C, Altamirano L, Cheney M, et
al. A multicenter, randomized, double-blind,
controlled trial of nebulized epinephrine in
infants with acute bronchiolitis. N Engl J Med 2003;349(1):27-35.
8. de Benedictis FM, Franceschini F, Budassi
R, et al. I corticosteroidi nelle malattie respiratorie:
certezze e dubbi 60 anni dopo (seconda
parte). Medico e Bambino 2012;31:
652-9.
9. Mandelberg A, Tal G, Witzling M, et al.
Nebulized 3% hypertonic saline solution
treatment in hospitalized infants with viral
bronchiolitis. Chest 2003;123(2):481-7.
10. Zhang L, Mendoza-Sassi RA, Wainwright
C, Klassen TP. Nebulised hypertonic saline
solution for acute bronchiolitis in infants. Cochrane
Database Syst Rev 2013;7:CD006458.
11. Wu S, Baker C, Lang ME, et al. Nebulized
hypertonic saline for bronchiolitis: a randomized
clinical trial. JAMA Pediatr 2014;
168(7):657-63.
12. Florin TA, Shaw KN, Kittick M, Yakscoe
S, Zorc JJ. Nebulized hypertonic saline for
bronchiolitis in the emergency department: a
randomized clinical trial. JAMA Pediatr 2014;
168(7):664-70.
13. Everard ML, Hind D, Ugonna K, et al. SABRE:
a multicentre randomised control trial
of nebulised hypertonic saline in infants hospitalised
with acute bronchiolitis. Thorax
2014;69(12):1105-12.
14. Kallappa C, Hufton M, Millen G, Ninan
TK. Use of high flow nasal cannula oxygen
(HFNCO) in infants with bronchiolitis on a
paediatric ward: a 3-year experience. Arch
Dis Child 2014;99(8):790-1
15. Wing R, James C, Maranda LS, Armsby
CC. Use of high-flow nasal cannula support
in the emergency department reduces the
need for intubation in pediatric acute respiratory
insufficiency. Pediatr Emerg Care 2012;
28(11):1117-23.
16. Beggs S, Wong ZH, Kaul S, Ogden KJ,
Walters JA. High-flow nasal cannula therapy
for infants with bronchiolitis. Cochrane Database
Syst Rev 2014;1:CD009609.
17. Schroeder AR, Marmor AK, Pantell RH,
Newman TB. Impact of pulse oximetry and
oxygen therapy on length of stay in bronchiolitis
hospitalizations. Arch Pediatr Adolesc
Med 2004;158(6):527-30.
18. Farley R, Spurling GK, Eriksson L, Del
Mar CB. Antibiotics for bronchiolitis in children
under two years of age. Cochrane Database
Syst Rev 2014;10:CD005189.
19. Thorburn K, Harigopal S, Reddy V, Taylor
N, van Saene HK. High incidence of pulmonary
bacterial co-infection in children with
severe respiratory syncytial virus (RSV)
bronchiolitis. Thorax 2006;61(7):611-5.
20. Chen CJ, Wu KG, Tang RB, Yuan HC,
Soong WJ, Hwang BT. Characteristics of Chlamydia
trachomatis infection in hospitalized
infants with lower respiratory tract infection.
J Microbiol Immunol Infect 2007;40(3):255-9.
21. Pinto LA, Pitrez PM, Luisi F, et al. Azithromycin
therapy in hospitalized infants with
acute bronchiolitis is not associated with better
clinical outcomes: a randomized, doubleblinded,
and placebo-controlled clinical trial.
J Pediatr 2012;161(6):1104-8.
22. McCallum GB, Morris PS, Chatfield MD,
et al. A single dose of azithromycin does not
improve clinical outcomes of children hospitalised
with bronchiolitis: a randomised, placebo-
controlled trial. PLoS One 2013;8(9):
e74316.
23. Oakley E, Borland M, Neutze J, et al; Paediatric
Research in Emergency Departments
International Collaborative (PREDICT). Nasogastric
hydration versus intravenous hydration
for infants with bronchiolitis: a randomised
trial. Lancet Respir Med 2013;1(2):
113-20.
24. Ho SW, Huang KY, Teng YH, Ku MS,
Chiou JY. Practice variations between emergency
physicians and pediatricians in treating
acute bronchiolitis in the Emergency
Department: A nationwide study. J Emerg
Med 2015;48(5):536-41.
Corrispondenza: federico.marchetti@ausl.ra.it
