Nasogastric hydration versus intravenous hydration for infants with bronchiolitis: a randomised trial

Oakley, Edward; Borland, Meredith L; Neutze, Jocelyn; Acworth, Jason; Krieser, David; Dalziel, Stuart R; Davidson, Andrew; Donath, Susan; Jachno, Kim; South, Mike; Theophilos, Theane; Babl, Franz E

doi:10.1016/s2213-2600(12)70053-x

Cited by 93 publications

(70 citation statements)

References 27 publications

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“…182 One study estimated that one-third of infants hospitalized for bronchiolitis require fluid replacement. 183 One case series 184 and 2 randomized trials, 185,186 examined the comparative efficacy and safety of the intravenous and nasogastric routes for fluid replacement. A pilot trial in Israel that included 51 infants younger than 6 months demonstrated no significant differences in the duration of oxygen needed or time to full oral feeds between infants receiving intravenous 5% dextrose in normal saline solution or nasogastric breast milk or formula.…”

Section: Action Statement Profile Kasmentioning

confidence: 99%

Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis

Ralston¹,

Lieberthal²,

Meissner³

et al. 2014

Pediatrics

1,421

1,654

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This guideline is a revision of the clinical practice guideline, “Diagnosis and Management of Bronchiolitis,” published by the American Academy of Pediatrics in 2006. The guideline applies to children from 1 through 23 months of age. Other exclusions are noted. Each key action statement indicates level of evidence, benefit-harm relationship, and level of recommendation. Key action statements are as follows:

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Section: Action Statement Profile Kasmentioning

confidence: 99%

Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis

Ralston¹,

Lieberthal²,

Meissner³

et al. 2014

Pediatrics

1,421

1,654

View full text Add to dashboard Cite

show abstract

“…Currently there is not sufficient evidence for or against the use of GT feeding in infants with bronchiolitis [46], and in a recent large study from Australia no differences in major outcomes were found between the two methods [48]. However, feeding by GT has been increasingly adopted, and used as routine in some countries [41,49,50], including the recent guidelines of the Norwegian Paediatric society [51].…”

Section: Methodsmentioning

confidence: 99%

Acute bronchiolitis in infants, a review

Øymar

Skjerven

Mikalsen

2014

Scand J Trauma Resusc Emerg Med

114

121

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Acute viral bronchiolitis is one of the most common medical emergency situations in infancy, and physicians caring for acutely ill children will regularly be faced with this condition. In this article we present a summary of the epidemiology, pathophysiology and diagnosis, and focus on guidelines for the treatment of bronchiolitis in infants. The cornerstones of the management of viral bronchiolitis are the administration of oxygen and appropriate fluid therapy, and overall a “minimal handling approach” is recommended. Inhaled adrenaline is commonly used in some countries, but the evidences are sparse. Recently, inhalation with hypertonic saline has been suggested as an optional treatment. When medical treatment fails to stabilize the infants, non-invasive and invasive ventilation may be necessary to prevent and support respiratory failure. It is important that relevant treatment algorithms exist, applicable to all levels of the treatment chain and reflecting local considerations and circumstances.

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“…5 The American Academy of Pediatrics guidelines recommend only supportive therapy that includes oxygen therapy for hypoxemia, respiratory support, and the maintenance of hydration. 5,6 Respiratory support as provided in emergency and ward settings has been limited to oxygen delivered through a standard nasal cannula, at a rate of up to 2 liters of 100% oxygen per minute, to treat hypoxemia. 7 The hallmark of severe bronchiolitis is small airway inflammation resulting in hypoxemia, hypercarbia, and increased work of breathing, 1 all of which respond to the provision of positive pressure.…”

mentioning

confidence: 99%

A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis

et al. 2018

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BACKGROUNDHigh-flow oxygen therapy through a nasal cannula has been increasingly used in infants with bronchiolitis, despite limited high-quality evidence of its efficacy. The efficacy of high-flow oxygen therapy through a nasal cannula in settings other than intensive care units (ICUs) is unclear. METHODSIn this multicenter, randomized, controlled trial, we assigned infants younger than 12 months of age who had bronchiolitis and a need for supplemental oxygen therapy to receive either high-flow oxygen therapy (high-flow group) or standard oxygen therapy (standard-therapy group). Infants in the standard-therapy group could receive rescue high-flow oxygen therapy if their condition met criteria for treatment failure. The primary outcome was escalation of care due to treatment failure (defined as meeting ≥3 of 4 clinical criteria: persistent tachycardia, tachypnea, hypoxemia, and medical review triggered by a hospital early-warning tool). Secondary outcomes included duration of hospital stay, duration of oxygen therapy, and rates of transfer to a tertiary hospital, ICU admission, intubation, and adverse events. RESULTSThe analyses included 1472 patients. The percentage of infants receiving escalation of care was 12% (87 of 739 infants) in the high-flow group, as compared with 23% (167 of 733) in the standard-therapy group (risk difference, −11 percentage points; 95% confidence interval, −15 to −7; P<0.001). No significant differences were observed in the duration of hospital stay or the duration of oxygen therapy. In each group, one case of pneumothorax (<1% of infants) occurred. Among the 167 infants in the standard-therapy group who had treatment failure, 102 (61%) had a response to high-flow rescue therapy. CONCLUSIONSAmong infants with bronchiolitis who were treated outside an ICU, those who received high-flow oxygen therapy had significantly lower rates of escalation of care due to treatment failure than those in the group that received standard oxygen therapy. Original ArticleThe New England Journal of Medicine 1122T h e ne w e ngl a nd jou r na l o f m e dicine B ronchiolitis, an acute lower airway lung disease that is generally caused by respiratory viruses, is the most common reason worldwide for nonelective hospital admission in infants. In the United States, bronchiolitis is responsible for $1.7 billion in hospitalization costs annually.1,2 In Australia and New Zealand, there has been a population-based increase in admissions to the intensive care unit (ICU) for bronchiolitis, with associated increases in hospital costs. 3Numerous studies have investigated the role of medical therapies 4 in infants with bronchiolitis; none of these interventions have shown efficacy. 5The American Academy of Pediatrics guidelines recommend only supportive therapy that includes oxygen therapy for hypoxemia, respiratory support, and the maintenance of hydration. 5,6 Respiratory support as provided in emergency and ward settings has been limited to oxygen delivered through a standard nasal cannula, at a rate of up to 2 li...

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Nasogastric hydration versus intravenous hydration for infants with bronchiolitis: a randomised trial

Cited by 93 publications

References 27 publications

Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis

Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis

Acute bronchiolitis in infants, a review

A Randomized Trial of High-Flow Oxygen Therapy in Infants with Bronchiolitis

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