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A predictable event in the paediatrician’s year is the advent of the bronchiolitis season somewhere around November or December, with large numbers of hospital admissions of infants, especially those under 6 months of age. This continues to occur despite recent developments including the availability of palivizumab for prophylaxis in high-risk infants.
The Scottish Intercollegiate Guidelines Network (SIGN) published an evidence-based guideline on the condition in November 2006.1 The guideline’s purpose is to reduce some of the reported variations in management, avoiding unnecessary tests and interventions. It covers prevention; recognition and differential diagnosis; indications for hospital admission and the in-patient management of infants with bronchiolitis; limiting disease transmission, and prognosis. Its scope includes infants up to 12 months of age and excludes management in intensive care.
This review highlights those aspects particularly relevant to paediatricians. The other recommendations in the guideline can readily be accessed from the SIGN website (http://www.sign.ac.uk).
The grading system gives a grade A to directly relevant evidence from randomised controlled trials (RCTs) with a low risk of bias; grade B to evidence from cohort or case control studies with a very low risk of bias or confounding and a strong likelihood that the relationship is causal, or extrapolated evidence from RCTs; grade C to less reliable evidence from cohort or case control studies; and grade D to evidence from case reports, case series or expert opinion. Good practice points (✓) represent the opinion of the guideline development group.
Routine use of palivizumab is not recommended (✓).
Palivizumab may be considered for use, on a case-by-case basis, in infants less than 12 months old with (✓):
acyanotic congenital heart disease
congenital or acquired significant orphan lung diseases*
A local lead specialist should work with the appropriate clinical teams to identify those …
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