Bronchiolitis: compliance with guidelines

Key words: Bronchiolitis, Infection, Lower respiratory tract, Nebuliser therapy, Hypertonic solution

Background - Bronchiolitis is the most common infection of the lower respiratory tract during the first year of life. The American Academy of Pediatrics (AAP) guidelines and the Italian Society of Paediatrics (SIP) Consensus underline that the diagnosis of bronchiolitis is based on the clinical history and the objective examination and that the key points of the treatment are mainly to guarantee a proper nutrition/hydration and to administer oxygen where necessary.
Objectives - To assess the compliance with international and national guidelines in hospital settings before and after sharing and discussing a care protocol.
Materials and Methods - Two groups consisting of 27 patients each affected by bronchiolitis were studied. The children of the first were hospitalised in 2014-2015 and were managed without complying with the unit protocol and those of the second group were hospitalised in 2015-2016, after the protocol sharing. Treatment modalities and the incidence of complication were compared.
Results - Following the sharing of the clinical protocol a trend towards the decrease in the use of the antibiotic therapy and steroids was observed. A larger use of nebuliser therapy with hypertonic solution was observed with respect to the sole physiological solution or the steroidal one. The duration of hospitalisation was similar in the two considered periods. No major complications were observed in both the above two periods.
Conclusions - The present study, though it considers a low number of samples, shows that the sharing of an internal protocol for the management of paediatric patients can allow resources to be optimised as well as ineffective and potentially dangerous treatments to be avoided.