Bronchiolitis is the most common acute lower respiratory tract infection and reason for hospitalization during Winter/Spring affecting children <2 years of age. It is usually caused by a virus (most frequently the respiratory syncytial virus – RSV, though other viruses (like adenovirus, human metapneumovirus, influenza or parainfluenza) may be involved. Infants who are born preterm, have chronic lung disease, complicated congenital heart disease, are immunodeficient or who have some other underlying chronic illness are at greatest risk. Guidelines of treatment from the American Academy of Pediatrics (AAP) emphasizes supportive care including hydration and oxygen. Most other treatments like bronchodilators, nebulized epinephrine, antibiotics, corticosteroids or chest physiotherapy have not been demonstrated to be of value when given routinely. Nevertheless “variation in practice continues with infants receiving non-evidence-based therapies”.
An international multi-center cluster clinical trial included 26 hospitals providing tertiary or secondary pediatric care, randomized 13 to an intervention program (which included site-based clinical lectures, meetings, a train-the-trainer workshop, education and promotional material, audit and feedback) or to control (13 without intervention) compared compliance of de-implementation of treatment success during the first 24 hours of care (measured by the non-use of chest x-ray, albuterol, glucocorticoids, antibiotics or epinephrine).
A targeted intervention program to decrease questionable treatments for bronchiolitis in infancy leads to improved care (85% vs 73% of intervened vs control hospitals).
(While statistically significant it appears to this observer that for the investment of time and effort the improvement is modest. Local department-based education may perhaps be equally or more effective. Ed).
