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Bronchiolitis in infants and children: Treatment; outcome; and prevention

Pedro A Piedra, MD
Ann R Stark, MD
Section Editors
George B Mallory, MD
Morven S Edwards, MD
Deputy Editor
Mary M Torchia, MD


Bronchiolitis, part of the spectrum of lower respiratory tract diseases, is a major cause of illness and hospitalization in infants and children younger than two years. The treatment, outcome, and prevention of bronchiolitis will be reviewed here. The epidemiology, clinical features, and diagnosis of bronchiolitis and the treatment of recurrent virus-induced wheezing in young children are discussed separately. (See "Bronchiolitis in infants and children: Clinical features and diagnosis" and "Treatment of recurrent virus-induced wheezing in young children".)


For the purposes of this topic review, bronchiolitis is broadly defined as a clinical syndrome that occurs in children <2 years of age and is characterized by upper respiratory symptoms (eg, rhinorrhea) followed by lower respiratory (eg, small airway/bronchiole) infection with inflammation, which results in wheezing and or crackles (rales). Bronchiolitis typically occurs with primary infection or reinfection with a viral pathogen, but occasionally is caused by bacteria (eg, Mycoplasma pneumoniae). In young children, the clinical syndrome of bronchiolitis may overlap with recurrent virus-induced wheezing and acute viral-triggered asthma. The diagnosis of bronchiolitis, virus-induced wheezing, and acute viral-triggered asthma are discussed separately. (See "Bronchiolitis in infants and children: Clinical features and diagnosis", section on 'Diagnosis' and "Virus-induced wheezing and asthma: An overview" and "Asthma in children younger than 12 years: Initial evaluation and diagnosis" and "Asthma in children younger than 12 years: Initial evaluation and diagnosis", section on 'Respiratory tract infections'.)


Consensus definitions for severe bronchiolitis are lacking. In general, we consider severe bronchiolitis to be indicated by any of the following:

Persistently increased respiratory effort (tachypnea; nasal flaring; intercostal, subcostal, or suprasternal retractions; accessory muscle use; grunting) as assessed during repeated examinations separated by at least 15 minutes

Hypoxemia (SpO2 <95 percent); SpO2 should be interpreted in the context of other clinical signs, the state of the patient (eg, awake, asleep, coughing, etc), and altitude


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