Hydration and nutrition

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Hydration and nutrition

Supplemental hydration should be provided to infants with bronchiolitis who cannot maintain hydration orally. (Evidence quality: NA; recommendation strength: strong)

Hydration status may be considered inadequate by reported <50% of normal intake, or evidenced by 5% weight loss or hypernatremia (if tested). After treatment of hypoxaemia, feeding is often improved.

When supplemental hydration is required, either nasogastric (NG) or intravenous (IV) routes are appropriate. (Evidence quality: moderate; recommendation strength: strong). However, the NG route should be the preferred first method. (Evidence quality: moderate; recommendation strength: weak). 

Consider either continuous or bolus methods of NG hydration using oral rehydration solution/breast milk or formula. (Evidence quality: moderate; recommendation strength: conditional).

Consider fluid restriction at 50-75% of normal weight-based fluid calculation for age over 24 hours to avoid fluid overload in infants with bronchiolitis. Careful monitoring of signs of over-hydration (facial and eye-lid oedema, weight increase) and under-hydration are needed. (Evidence quality: NA; recommendation strength: consensus-based) 

There is a risk of increased antidiuretic hormone secretion and hyponatremia.

Consider enteral feeding (NG or oral) in infants receiving HF therapy, if tolerated. (evidence quality: very low; recommendation strength: weak). 

Continuous NG feeding can be considered in infants receiving CPAP therapy who are not judged to be at imminent risk of intubation. (Evidence quality: very low; recommendation strength: consensus-based)

In infants requiring IV hydration, consider using either 0.9% sodium chloride (normal saline) with 5% glucose, or balanced fluid (e.g., Plasma-lyte 148TM or Hartmann’s solution) with 5% glucose, for use as maintenance fluid in infants admitted to hospital with bronchiolitis requiring IV hydration. For infants aged up to 4 weeks corrected with bronchiolitis, consider 10% glucose, or monitoring of blood sugar levels if receiving 5% glucose. (Evidence quality: NA; recommendation strength: consensus-based)