Bronchiolitis in Neonates

[gmustafa]

I would like to get the opinion of our respected colleagues regarding management of Bronchiolitis in NICU. Do you use hypertonic saline, salbutamol or ipratropium nebulizers? Please share your thoughts. Thanks.

[Stefan Johansson]

Thanks for posting!

I am sorry but I cannot give advice on this matter as we don't keep/admit infants with bronchiolitis in the NICU, they are transferred to a PICU or a regular pediatric ward (to avoid viral spread in the NICU).

Would be interesting to hear what bronchiolitis cases you have in the NICU. Also infants admitted from home? If yes, what is your policies/guidelines to avoid spread to other infants? Single rooming?

[bimalc]

My current units do not admit babies who have been home for exactly the reason @Stefan Johansson said.  However, I trained at two children's hospitals that did admit such babies.  The mainstay of therapy is supportive care: positive pressure as needed, vigorous airway suction, recognition that apnea is common in RSV with neonates and that intubation can be more challenging than 'typical' neonatal intubation because these patients are often much larger than what we are used to (and thus good access and premedication for intubation under controlled conditions is VERY beneficial).  Of the listed inhalation therapies hypertonic saline can perhaps shorten length of stay by <1 day.  When the diagnosis is known (and assuming this is a previously healthy term baby) there is little indication for albuterol/atrovent (except maybe albuterol for bronchospasm after hypertonic saline).  

Sorry, not a lot of data, just anecdote.

[TMohns]

We admit patients with bronchiolitis ore other viral infections which are spread aerogen on our NICU from home, regional hospitals or other wards in our hospital.  I'm working in The Netherlands where Intensive Care is highly centralized in 10 NICU's and 7 PICU's. We had trouble with the nationally bed capacity (PICU) and transport distances.  So we started in our department treating these patients to solve this problem although we were not really happy about the risk we had to accept. This happend  from 2006 in an "Open Bay" unit and we used  strict  protocols which we developed together with our department for hospital infection control. The incubator is a goed first step for isolation and the next is distance of minimal 3 meters (1 bedplace) and very strict hand desinfection and management of contaminated equipment.

Since 2012 we have a new NICU unit with single rooms (2 for really isolation)  where we admit also patients with RSV. Our population is up to 3 months if there is lack of PICU beds but we try to avoid as much as possible these patients on our unit.

We had no proven transfer from one patient to another in the last 13 years.

[gmustafa]

On 2/20/2020 at 7:40 PM, Stefan Johansson said:

Thanks for posting!

I am sorry but I cannot give advice on this matter as we don't keep/admit infants with bronchiolitis in the NICU, they are transferred to a PICU or a regular pediatric ward (to avoid viral spread in the NICU).

Would be interesting to hear what bronchiolitis cases you have in the NICU. Also infants admitted from home? If yes, what is your policies/guidelines to avoid spread to other infants? Single rooming?

We have 7 bed NICU with one isolation room. We do admit patients upto age of 28 days. Patients with bronchiolitis are admitted from emergency room to the isolation. However if isolation room is occupied then these neonates are admitted to NICU. Our supportive treatment includes oxygenation, suction, hypertonic saline nebs and somtimes salbutamol nebs.

[agoz]

we admit in isolation rooms