What level of care is required for infants with bronchiolitis

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What level of care is required for infants with bronchiolitis?

Within Australia and Aotearoa New Zealand, management of bronchiolitis is such, that while tertiary children’s hospitals may see patients who move through the various levels of care from ED to inpatient ward to ICU based on the settings that the studies have occurred in, this may not be reflective of care in metropolitan, regional, and rural hospitals, where most infants with bronchiolitis are seen. In these hospitals, bronchiolitis patients with severe disease may be managed for some time in an ED or inpatient paediatric ward prior to transfer to a tertiary children’s hospital ICU or managed in an adult ICU without transfer. Transfer should occur safely according to local protocols.

The appropriate setting for delivery of care should reflect resources and skills that are available, rather than a specific physical location or label. 

• Standard nursing ratios in the ED and ward environment are suitable for infants with mild or moderate bronchiolitis (Table 2).
  • For mild disease, no hydration or respiratory support is required, and these infants are usually managed in ED and as an outpatient.
  • For moderate disease, hydration support and/or oxygen therapy (low flow or HF oxygen) can be safely delivered in an ED or ward environment with standard nursing ratios.
• Standard nursing ratios in the ED and ward environment have been shown to be safe for stable infants on HF therapy.

Severe bronchiolitis (Table 2) requires either a 1:1 or 1:2 nursing ratio. This will usually require HDU/ICU care, or escalation to a higher level of care depending on the health facility, and may involve transport to an HDU/ICU or higher-level facility. Post stabilisation of severe bronchiolitis with improvement in condition, nursing ratios can be revised.