1
, Annamaria Staiano2
, Luigi Orfeo3
, Fabio Midulla4
, Gian Luigi Marseglia5
, Chiara Ghizzi
6
,
Stefania Zampogna7
, Virgilio Paolo Carnielli
8
, Silvia Favilli
9
, Martino Ruggieri
10
, Domenico Perri
11
,
Giuseppe Di Mauro12
, Guido Castelli Gattinara13
, Antonio D’Avino14
, Paolo Becherucci
15
, Arcangelo Prete16
,
Giuseppe Zampino17
, Marcello Lanari
18
, Paolo Biban19
, Paolo Manzoni
20,21
, Susanna Esposito22
,
Giovanni Corsello23
and Eugenio Baraldi
24*
Abstract
Bronchiolitis is an acute respiratory illness that is the leading cause of hospitalization in young children. This document
aims to update the consensus document published in 2014 to provide guidance on the current best practices
for managing bronchiolitis in infants. The document addresses care in both hospitals and primary care. The diagnosis
of bronchiolitis is based on the clinical history and physical examination. The mainstays of management are largely
supportive, consisting of fuid management and respiratory support. Evidence suggests no beneft with the use of
salbutamol, glucocorticosteroids and antibiotics with potential risk of harm. Because of the lack of efective treatment,
the reduction of morbidity must rely on preventive measures. De-implementation of non-evidence-based interventions
is a major goal, and educational interventions for clinicians should be carried out to promote high-value care
of infants with bronchiolitis. Well-prepared implementation strategies to standardize care and improve the quality
of care are needed to promote adherence to guidelines and discourage non-evidence-based attitudes. In parallel,
parents’ education will help reduce patient pressure and contribute to inappropriate prescriptions. Infants with
pre-existing risk factors (i.e., prematurity, bronchopulmonary dysplasia, congenital heart diseases, immunodefciency,
neuromuscular diseases, cystic fbrosis, Down syndrome) present a signifcant risk of severe bronchiolitis and should
be carefully assessed. This revised document, based on international and national scientifc evidence, reinforces the
current recommendations and integrates the recent advances for optimal care and prevention of acute bronchiolitis.
Keywords Bronchiolitis, Guidelines, Infants, Respiratory syncytial virus, Update, Prevention
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