Overcoming the Bronchiolitis Blues: Embracing Global Collaboration and Disease Heterogeneity.

Abstract

* Abbreviation: RSV — : respiratory syncytial virus Although bronchiolitis is 1 of the most common conditions in infancy, no medicine has been proven to be consistently beneficial. As a result, the primary objective of frontline providers in primary care and emergency medicine is to triage infants to the appropriate level of care (ie, home, hospital ward, or intensive care) for their hydration and respiratory needs.1 However, prospectively validated risk-stratification tools for infants with bronchiolitis do not exist for frontline providers. Freire et al,2 as part of the Pediatric Emergency Research Networks, addressed this knowledge gap by analyzing data that were collected from 38 emergency departments across the globe to develop a bronchiolitis risk score. In the resulting article,2 the authors report that the usual suspects (ie, being ≤2 months of age; having apnea; oxygen saturation of <90%; signs of increased work of breathing [including nasal flaring, grunting, and retractions]; and dehydration and/or poor feeding) were all predictive of escalated care, which is defined as hospitalization with a high-flow nasal cannula, noninvasive or invasive ventilation, or intensive care admission. Although many clinicians feel comfortable triaging infants with bronchiolitis at either … Address correspondence to Jonathan M. Mansbach, MD, MPH, Department of Medicine, Boston Children’s Hospital, 300 Longwood Ave, 9 S. 9157, Boston, MA 02115. E-mail: jonathan.mansbach{at}childrens.harvard.edu