is the first episode of wheezing in a child younger than 12 to 24 months who has physical findings of a viral respiratory infection and has no other explanation for the wheezing, such as pneumonia or atopy.
Hemodynamically significant congenital heart disease (eg, moderate to severe pulmonary hypertension, cyanotic heart disease, or congenital heart disease that requires medication to control heart failure)
Studies evaluating whether radiographic findings are predictive of disease severity have had conflicting results.
One study randomly assigned 522 infants (2 to 59 months) with acute LRTI to receive or not receive a chest radiograph.
Children in the radiograph group were more likely to be diagnosed with pneumonia or upper respiratory infection, whereas children in the no-radiograph group were more likely to be diagnosed with bronchiolitis.
In addition, more likely to be treated with antibiotics. The median time to recovery was seven days in both groups.
Swingler , GH, Hussey, GD, Zwarenstein , M . Randomised controlled trial of clinical outcome after chest radiograph in ambulatory acute lower - respiratory infection in children . Lancet 1998; 351:404 .
A systematic review of three randomized trials concluded that chest physiotherapy using vibration and percussion did not improve clinical score, reduce supplemental oxygen requirement, or reduce length of hospital stay.
Outcomes in the dexamethasone and epinephrine monotherapy groups did not differ significantly from those in the placebo group.
Com. was associated with a decreased rate of hospitalization one week after enrollment (17 versus 24 to 26 percent in the other groups), but the result was not significant when adjusted for multiple comparisons (relative risk, 0.65, adjusted 95% CI 0.41-1.03).
N Engl J Med . 2009 May 14;360(20):2079-89. Epinephrine and dexamethasone in children with bronchiolitis. Pediatric Emergency Research Canada (PERC)
use of IV immunoglobulin with a high neutralizing activity against RSV (RSV-IGIV, which has been discontinued) or RSV-specific humanized monoclonal antibody ( palivizumab ) has failed to improve outcomes in infants with or without risk factors, hospitalized with RSV infection
Its role in Rx, was evaluated in a randomized trial in 53 infants and young children (>4 weeks to ≤ 2 years; mean age 3.8 months).
Treatment with montelukast did not affect the clinical course, oxygen saturation, length of stay, or cytokine levels.
Additional studies are necessary to determine what role, if any.
CONCLUSIONS : Montelukast did not improve the clinical course in acute bronchiolitis . No significant effect of montelukast on the T - helper 2 / T - helper 1 cytokine ratio when given in the early acute phase could be demonstrated .
Bronchiolitis: Recent Evidence on Diagnosis and Management Joseph J. Zorc and Caroline Breese Hall Pediatrics 2010;125;342-349; originally published online Jan 25, 2010; DOI: 10.1542/peds.2009-2092