Summary of key changes in recommendations between the 2016 guideline and 2025 update

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Summary of key changes in recommendations between the 2016 guideline and the 2025 update

This section presents a summary of key changes in the recommendations between the 2016 Australasian Bronchiolitis Guideline and the 2025 update. A summary of the changes and the original recommendations are presented. 

TOPIC NO. CHANGE SUMMARY of CHANGES 2016 RECOMMENDATION
Physical exam and history 1 ✓ The key clinical signs and symptoms of bronchiolitis have not changed. However, additional signs have been added: feeding difficulties, vomiting, dehydration, hypoxaemia, lethargy, uncommon (<5%) diarrhoea, and rarely (<2%) apnoea. Infants can be diagnosed with bronchiolitis if they have an upper respiratory tract infection followed by onset of respiratory distress with fever, and one or more of: cough, tachypnoea, retractions, diffuse crackles or wheeze.
Risk factors 2 ✓ Additional risk factors added: trisomy 21, economic disadvantage, CDH, genetic disorders, and timing of illness onset. In 2025, risk factors are viewed as continuous (e.g., lower gestational age = increased risk). Clinicians should consider risk factors such as gestational age <37 weeks, age at presentation <10 weeks, exposure to cigarette smoke, breastfeeding <2 months, chronic conditions, and Indigenous ethnicity.
CXR 3b NA New topic to the 2025 guideline update. NA
3c NA New topic to the 2025 guideline update. NA
Laboratory tests 4a ✓ Urine testing for UTI in bronchiolitis with fever was removed. Glucose and/or sodium tests may be considered in infants with poor feeding, dehydration, or altered mental state. Routine blood/urine testing is not recommended. For infants <2 months with fever >38°C, clinicians may consider a urine test for possible UTI.
4b NA New topic to the 2025 guideline update. NA
4c NA New topic to the 2025 guideline update. NA
Criteria for safe discharge 7 ✓ A prescriptive discharge flow chart was added. Criteria revised to include specific oxygen saturation targets, feeding indicators, and social factors (e.g., caregiver education, transport, local follow-up). Oxygen saturation, feeding adequacy, infant age, and social support should be considered at discharge. No absolute discharge criteria recommended.
Glucocorticoids 11c ✓ 2025 update allows glucocorticoid and adrenaline/epinephrine therapy for **severe** bronchiolitis in ICU settings. Otherwise, routine use is discouraged. Do not use combined glucocorticoids and adrenaline/epinephrine for bronchiolitis.
Saturation targets 12b ✓ Supplemental oxygen recommended if **SpO₂ <90%** in infants ≥6 weeks. For infants <6 weeks or those with underlying conditions, oxygen should be used if **SpO₂ <92%**. Oxygen should be used if SpO₂ <92%. Oxygen should be discontinued at SpO₂ ≥92%.
Non-oral hydration 20b ✓ Clinicians can use **continuous or bolus** NG hydration with oral rehydration solution, breast milk, or formula. NG is the preferred first-line method. Both NG and IV hydration are acceptable.
Infection control practices 21 ✓ Hand hygiene and cohorting still recommended. 2025 update suggests **multicomponent infection control measures** (e.g., masks, gowns). Hand hygiene is the most effective intervention.
SARS-CoV-2 co-infection 22a NA New topic to the 2025 guideline update. NA

Note. The recommendations were not reported as changed in instances where there were minor changes to the wording of the recommendation, but the recommended action had not changed. For details of all recommendations, refer to the main report (Table 6: recommendations from the 2025 Australasian Bronchiolitis Guideline update). 

CDH = Congenital diaphragmatic hernia; ED = Emergency department; GRADE = Grading of Recommendations Assessment, Development and Evaluation; ICU = Intensive care unit; IM = Intramuscular; IV = Intravenous; NG = Nasogastric; NHMRC = National Health and Medical Research Council; RSV = Respiratory syncytial virus; SARS-CoV-2 = Severe acute respiratory syndrome coronavirus 2; UTI = Urinary tract infection.