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gmustafa

Bronchiolitis in Neonates

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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.

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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?

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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.

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