{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T08:31:07Z","timestamp":1792657867356,"version":"4.5.0"},"reference-count":72,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"9","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pediatr Emer Care"],"published-print":{"date-parts":[[2019,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n          <jats:p>The 2014 American Academy of Pediatrics bronchiolitis guidelines do not adequately serve the needs and clinical realities of front-line clinicians caring for undifferentiated wheezing infants and children. This article describes the clinical challenges of evaluating and managing a heterogeneous disease syndrome presenting as undifferentiated patients to the emergency department. Although the 2014 American Academy of Pediatrics bronchiolitis guidelines and the multiple international guidelines that they closely mirror have made a good faith attempt to provide clinicians with the best evidence-based recommendations possible, they have all failed to address practical, front-line clinical challenges. The therapeutic nihilism of the guidelines and the dissonance between many of the recommendations and frontline realities have had wide-ranging consequences. Nevertheless, newer evidence of therapeutic options is emerging and forecasts hope for more therapeutically optimistic recommendations with the next revision of the guidelines.<\/jats:p>","DOI":"10.1097\/pec.0000000000001915","type":"journal-article","created":{"date-parts":[[2019,8,24]],"date-time":"2019-08-24T13:32:20Z","timestamp":1566653540000},"page":"654-658","source":"Crossref","is-referenced-by-count":9,"title":["The Problematic 2014 American Academy of Pediatrics Bronchiolitis Guidelines"],"prefix":"10.1097","volume":"35","author":[{"given":"Larry B.","family":"Mellick","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Juan","family":"Gonzalez","sequence":"additional","affiliation":[{"name":"Pediatrics, Children's & Women's Hospital, University of South Alabama, Mobile, AL."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2019,8,30]]},"reference":[{"key":"bib1-20230930","doi-asserted-by":"crossref","first-page":"e1474","DOI":"10.1542\/peds.2014-2742","article-title":"Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis","volume":"134","year":"2014","journal-title":"Pediatrics"},{"key":"bib2-20230930","doi-asserted-by":"crossref","first-page":"1774","DOI":"10.1542\/peds.2006-2223","article-title":"Diagnosis and management of bronchiolitis","volume":"118","year":"2006","journal-title":"Pediatrics"},{"key":"bib3-20230930","doi-asserted-by":"crossref","first-page":"pii: e20170092","DOI":"10.1542\/peds.2017-0092","article-title":"International variation in asthma and bronchiolitis guidelines","volume":"140","year":"2017","journal-title":"Pediatrics"},{"key":"bib4-20230930","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1111\/jpc.14160","article-title":"Evaluation of national guidelines for bronchiolitis: AGREEments and controversies","volume":"55","year":"2019","journal-title":"J Paediatr Child Health"},{"key":"bib5-20230930","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1016\/S0140-6736(16)30951-5","article-title":"Viral bronchiolitis","volume":"389","year":"2017","journal-title":"Lancet"},{"key":"bib6-20230930","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1111\/jpc.14104","article-title":"Australasian bronchiolitis guideline","volume":"55","year":"2019","journal-title":"J Paediatr Child Health"},{"key":"bib8-20230930","doi-asserted-by":"crossref","first-page":"950","DOI":"10.1097\/INF.0b013e31829b7e43","article-title":"Viral etiologies of infant bronchiolitis, croup and upper respiratory illness during 4 consecutive years","volume":"32","year":"2013","journal-title":"Pediatr Infect Dis J"},{"key":"bib9-20230930","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1111\/all.13624","article-title":"EAACI Task Force on Clinical Practice Recommendations on Preschool Wheeze. Bronchiolitis needs a revisit: Distinguishing between virus entities and their treatments","volume":"74","year":"2019","journal-title":"Allergy"},{"key":"bib10-20230930","doi-asserted-by":"crossref","first-page":"915","DOI":"10.1093\/infdis\/jiv513","article-title":"Virus type and genomic load in acute bronchiolitis: severity and treatment response with inhaled adrenaline","volume":"213","year":"2016","journal-title":"J Infect Dis"},{"key":"bib11-20230930","doi-asserted-by":"crossref","first-page":"796","DOI":"10.1111\/pai.12318","article-title":"The first wheezing episode: respiratory virus etiology, atopic characteristics, and illness severity","volume":"25","year":"2014","journal-title":"Pediatr Allergy Immunol"},{"key":"bib12-20230930","doi-asserted-by":"crossref","first-page":"700","DOI":"10.1001\/archpediatrics.2011.1669","article-title":"Prospective multicenter study of viral etiology and hospital length of stay in children with severe bronchiolitis","volume":"166","year":"2012","journal-title":"Arch Pediatr Adolesc Med"},{"key":"bib13-20230930","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1136\/thoraxjnl-2016-208535","article-title":"A clustering approach to identify severe bronchiolitis profiles in children","volume":"71","year":"2016","journal-title":"Thorax"},{"key":"bib14-20230930","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1097\/INF.0b013e31818ee0c1","article-title":"Bronchiolitis: age and previous wheezing episodes are linked to viral etiology and atopic characteristics","volume":"28","year":"2009","journal-title":"Pediatr Infect Dis J"},{"key":"bib15-20230930","doi-asserted-by":"crossref","first-page":"691","DOI":"10.1016\/j.jaci.2014.07.001","article-title":"Short- and long-term efficacy of prednisolone for first acute rhinovirus-induced wheezing episode","volume":"135","year":"2015","journal-title":"J Allergy Clin Immunol"},{"key":"bib16-20230930","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1097\/01.inf.0000215226.69696.0c","article-title":"Evaluation of the efficacy of prednisolone in early wheezing induced by rhinovirus or respiratory syncytial virus","volume":"25","year":"2006","journal-title":"Pediatr Infect Dis J"},{"key":"bib17-20230930","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1016\/j.jpeds.2016.01.041","article-title":"Children hospitalized with rhinovirus bronchiolitis have asthma-like characteristics","volume":"172","year":"2016","journal-title":"J Pediatr"},{"key":"bib18-20230930","doi-asserted-by":"crossref","first-page":"1160","DOI":"10.1093\/infdis\/jix680","article-title":"Respiratory syncytial virus and rhinovirus bronchiolitis are associated with distinct metabolic pathways","volume":"217","year":"2018","journal-title":"J Infect Dis"},{"key":"bib19-20230930","doi-asserted-by":"crossref","first-page":"891","DOI":"10.1080\/17476348.2016.1190647","article-title":"Advancing our understanding of infant bronchiolitis through phenotyping and endotyping: clinical and molecular approaches","volume":"10","year":"2016","journal-title":"Expert Rev Respir Med"},{"key":"bib20-20230930","doi-asserted-by":"crossref","first-page":"570","DOI":"10.1016\/j.jaci.2006.11.003","article-title":"Prednisolone reduces recurrent wheezing after a first wheezing episode associated with rhinovirus infection or eczema","volume":"119","year":"2007","journal-title":"J Allergy Clin Immunol"},{"key":"bib21-20230930","doi-asserted-by":"crossref","first-page":"988","DOI":"10.1016\/j.jaci.2016.12.991","article-title":"Rhinovirus-induced first wheezing episode predicts atopic but not nonatopic asthma at school age","volume":"140","year":"2017","journal-title":"J Allergy Clin Immunol"},{"key":"bib22-20230930","doi-asserted-by":"crossref","first-page":"2059","DOI":"10.1002\/jmv.24587","article-title":"Rhinovirus species and clinical characteristics in the first wheezing episode in children","volume":"88","year":"2016","journal-title":"J Med Virol"},{"key":"bib23-20230930","doi-asserted-by":"crossref","first-page":"1095","DOI":"10.3201\/eid1006.030629","article-title":"Respiratory picornaviruses and respiratory syncytial virus as causative agents of acute expiratory wheezing in children","volume":"10","year":"2004","journal-title":"Emerg Infect Dis"},{"key":"bib24-20230930","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1016\/j.bjid.2015.12.005","article-title":"Prevalence of rhinovirus in wheezing children: a comparison with respiratory syncytial virus wheezing","volume":"20","year":"2016","journal-title":"Braz J Infect Dis"},{"key":"bib25-20230930","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1183\/09031936.00203511","article-title":"Rhinovirus infections in infancy and early childhood","volume":"41","year":"2013","journal-title":"Eur Respir J"},{"key":"bib26-20230930","doi-asserted-by":"crossref","first-page":"e49","DOI":"10.1542\/peds.110.4.e49","article-title":"Differences in admission rates of children with bronchiolitis by pediatric and general emergency departments","volume":"110","year":"2002","journal-title":"Pediatrics"},{"key":"bib27-20230930","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1097\/INF.0b013e3182a5f324","article-title":"Temporal trends in emergency department visits for bronchiolitis in the United States, 2006 to 2010","volume":"33","year":"2014","journal-title":"Pediatr Infect Dis J"},{"key":"bib28-20230930","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1097\/PEC.0b013e3182440b9b","article-title":"Bronchiolitis: clinical characteristics associated with hospitalization and length of stay","volume":"28","year":"2012","journal-title":"Pediatr Emerg Care"},{"key":"bib29-20230930","doi-asserted-by":"crossref","first-page":"648","DOI":"10.1136\/adc.2010.201079","article-title":"Clinical predictors of admission in infants with acute bronchiolitis","volume":"96","year":"2011","journal-title":"Arch Dis Child"},{"key":"bib30-20230930","doi-asserted-by":"crossref","first-page":"e17","DOI":"10.1111\/j.1651-2227.2011.02181.x","article-title":"Incidence and predisposing factors for severe disease in previously healthy term infants experiencing their first episode of bronchiolitis","volume":"100","year":"2011","journal-title":"Acta Paediatr"},{"key":"bib31-20230930","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1111\/j.1651-2227.2010.01714.x","article-title":"Detection of new respiratory viruses in hospitalized infants with bronchiolitis: a three-year prospective study","volume":"99","year":"2010","journal-title":"Acta Paediatr"},{"key":"bib32-20230930","doi-asserted-by":"crossref","first-page":"1429","DOI":"10.1007\/s00431-014-2334-2","article-title":"Virologic testing in bronchiolitis: does it change management decisions and predict outcomes?","volume":"173","year":"2014","journal-title":"Eur J Pediatr"},{"key":"bib33-20230930","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1111\/resp.12684","article-title":"Clinical predictors of hospital admission in acute lower respiratory tract infection in 2 months to 2-year-old children","volume":"21","year":"2016","journal-title":"Respirology"},{"key":"bib34-20230930","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1007\/s12519-017-0031-8","article-title":"Etiology and clinical features of viral bronchiolitis in infancy","volume":"13","year":"2017","journal-title":"World J Pediatr"},{"key":"bib35-20230930","doi-asserted-by":"crossref","first-page":"pii: e20160625","DOI":"10.1542\/peds.2016-0625","article-title":"RAD: reactive airways disease or really asthma disease?","volume":"139","year":"2017","journal-title":"Pediatrics"},{"key":"bib36-20230930","doi-asserted-by":"crossref","first-page":"152","DOI":"10.5492\/wjccm.v4.i3.152","article-title":"From bronchiolitis guideline to practice: a critical care perspective","volume":"4","year":"2015","journal-title":"World J Crit Care Med"},{"key":"bib37-20230930","doi-asserted-by":"crossref","first-page":"e556","DOI":"10.1542\/peds.2014-3676A","article-title":"The recommendation to not use bronchodilators is not supported by the evidence","volume":"135","year":"2015","journal-title":"Pediatrics"},{"key":"bib38-20230930","doi-asserted-by":"crossref","first-page":"85","DOI":"10.5811\/westjem.2015.1.24930","article-title":"American Academy of Pediatrics 2014 bronchiolitis guidelines: bonfire of the evidence","volume":"16","year":"2015","journal-title":"West J Emerg Med"},{"key":"bib39-20230930","doi-asserted-by":"crossref","first-page":"46","DOI":"10.2310\/8000.2013.131325","article-title":"Bronchodilator and steroid use for the management of bronchiolitis in Canadian pediatric emergency departments","volume":"17","year":"2015","journal-title":"CJEM"},{"key":"bib40-20230930","doi-asserted-by":"crossref","first-page":"pii: e20174105","DOI":"10.1542\/peds.2017-4105","article-title":"Respiratory viruses and treatment failure in children with asthma exacerbation","volume":"142","year":"2018","journal-title":"Pediatrics"},{"key":"bib41-20230930","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1097\/WOX.0b013e318216b41f","article-title":"Wheezing in infancy","volume":"4","year":"2011","journal-title":"World Allergy Organ J"},{"key":"bib42-20230930","first-page":"CD006458","article-title":"Nebulised hypertonic saline solution for acute bronchiolitis in infants","volume":"12","year":"2017","journal-title":"Cochrane Database Syst Rev"},{"key":"bib43-20230930","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1542\/peds.2015-1914","article-title":"Nebulized hypertonic saline for acute bronchiolitis: a systematic review","volume":"136","year":"2015","journal-title":"Pediatrics"},{"key":"bib44-20230930","first-page":"7","article-title":"Hypertonic saline for the treatment of bronchiolitis in infants and young children: a critical review of the literature","volume":"21","year":"2016","journal-title":"J Pediatr Pharmacol Ther"},{"key":"bib45-20230930","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1016\/j.pedneo.2013.09.013","article-title":"Nebulized hypertonic saline treatment reduces both rate and duration of hospitalization for acute bronchiolitis in infants: an updated meta-analysis","volume":"55","year":"2014","journal-title":"Pediatr Neonatol"},{"key":"bib46-20230930","doi-asserted-by":"crossref","first-page":"788","DOI":"10.1001\/jamapediatrics.2015.0681","article-title":"A living systematic review of nebulized hypertonic saline for acute bronchiolitis in infants","volume":"169","year":"2015","journal-title":"JAMA Pediatr"},{"key":"bib47-20230930","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1111\/j.1553-2712.2000.tb01258.x","article-title":"The efficacy of nebulized racemic epinephrine in children with acute asthma: a randomized, double-blind trial","volume":"7","year":"2000","journal-title":"Acad Emerg Med"},{"key":"bib48-20230930","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1017\/S1481803500015220","article-title":"Nebulized racemic epinephrine used in the treatment of severe asthmatic exacerbation: a case report and literature review","volume":"9","year":"2007","journal-title":"CJEM"},{"key":"bib49-20230930","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1016\/j.ajem.2005.10.008","article-title":"Comparison between nebulized adrenaline and beta2 agonists for the treatment of acute asthma. A meta-analysis of randomized trials","volume":"24","year":"2006","journal-title":"Am J Emerg Med"},{"key":"bib50-20230930","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/j.jcrc.2004.04.005","article-title":"Comparison of nebulized epinephrine and terbutaline in patients with acute severe asthma: a controlled trial","volume":"19","year":"2004","journal-title":"J Crit Care"},{"key":"bib51-20230930","first-page":"CD003123","article-title":"Epinephrine for bronchiolitis","year":"2004","journal-title":"Cochrane Database Syst Rev"},{"key":"bib52-20230930","first-page":"CD003123","article-title":"Epinephrine for bronchiolitis","year":"2011","journal-title":"Cochrane Database Syst Rev"},{"key":"bib53-20230930","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1016\/j.annemergmed.2012.09.014","article-title":"In infants younger than 24 months old and with bronchiolitis, does nebulized epinephrine improve clinical status?","volume":"61","year":"2013","journal-title":"Ann Emerg Med"},{"key":"bib54-20230930","article-title":"High-flow nasal cannula therapy for infants with bronchiolitis","year":"2014","journal-title":"Cochrane Database of Systematic Reviews"},{"key":"bib55-20230930","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1056\/NEJMoa1714855","article-title":"A randomized trial of high-flow oxygen therapy in infants with bronchiolitis","volume":"378","year":"2018","journal-title":"N Engl J Med"},{"key":"bib56-20230930","doi-asserted-by":"crossref","first-page":"930","DOI":"10.1016\/S0140-6736(17)30061-2","article-title":"High-flow warm humidified oxygen versus standard low-flow nasal cannula oxygen for moderate bronchiolitis (HFWHO RCT): an open, phase 4, randomized controlled trial","volume":"389","year":"2017","journal-title":"Lancet"},{"key":"bib57-20230930","doi-asserted-by":"crossref","first-page":"634","DOI":"10.1016\/j.jpeds.2009.10.039","article-title":"High flow nasal cannulae therapy in infants with bronchiolitis","volume":"156","year":"2010","journal-title":"J Pediatr"},{"key":"bib58-20230930","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1111\/jpc.13564","article-title":"Humidified high-flow nasal cannula oxygen in bronchiolitis reduces need for invasive ventilation but not intensive care admission","volume":"53","year":"2017","journal-title":"J Paediatr Child Health"},{"key":"bib59-20230930","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1007\/s00134-016-4617-8","article-title":"High flow nasal cannula (HFNC) versus nasal continuous positive airway pressure (nCPAP) for the initial respiratory management of acute viral bronchiolitis in young infants: a multicenter randomized controlled trial (TRAMONTANE study)","volume":"43","year":"2017","journal-title":"Intensive Care Med"},{"key":"bib60-20230930","doi-asserted-by":"crossref","first-page":"1299","DOI":"10.1007\/s00431-018-3191-1","article-title":"Using a high-flow nasal cannula provides superior results to OxyMask delivery in moderate to severe bronchiolitis: a randomized controlled study","volume":"177","year":"2018","journal-title":"Eur J Pediatr"},{"key":"bib61-20230930","first-page":"e368","article-title":"Using a high-flow nasal cannula provided superior results to low-flow oxygen delivery in moderate to severe bronchiolitis","volume":"105","year":"2016","journal-title":"Acta Paediatr"},{"key":"bib62-20230930","doi-asserted-by":"crossref","first-page":"1023","DOI":"10.4187\/respcare.05153","article-title":"High-flow nasal cannula utilization in pediatric critical care","volume":"62","year":"2017","journal-title":"Respir Care"},{"key":"bib63-20230930","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1097\/PCC.0000000000000985","article-title":"The clinical impact of heated humidified high-flow nasal cannula on pediatric respiratory distress","volume":"18","year":"2017","journal-title":"Pediatr Crit Care Med"},{"key":"bib64-20230930","doi-asserted-by":"crossref","first-page":"e214","DOI":"10.1097\/PCC.0000000000000112","article-title":"Physiologic effect of high-flow nasal cannula in infants with bronchiolitis","volume":"15","year":"2014","journal-title":"Pediatr Crit Care Med"},{"key":"bib65-20230930","doi-asserted-by":"crossref","first-page":"880","DOI":"10.4187\/respcare.04042","article-title":"Aerosol therapy during noninvasive ventilation or high-flow nasal cannula","volume":"60","year":"2015","journal-title":"Respir Care"},{"key":"bib66-20230930","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1186\/s13613-018-0473-8","article-title":"Nasal high-flow bronchodilator nebulization: a randomized cross-over study","volume":"8","year":"2018","journal-title":"Ann Intensive Care"},{"key":"bib67-20230930","doi-asserted-by":"crossref","first-page":"e161","DOI":"10.4187\/respcare.03996","article-title":"High-flow nasal cannula and aerosolized \u03b2 agonists for rescue therapy in children with bronchiolitis: a case series","volume":"60","year":"2015","journal-title":"Respir Care"},{"key":"bib68-20230930","doi-asserted-by":"crossref","first-page":"886","DOI":"10.4187\/respcare.05880","article-title":"Incorporating a nebulizer system into high-flow nasal cannula improves comfort in infants with bronchiolitis","volume":"63","year":"2018","journal-title":"Respir Care"},{"key":"bib69-20230930","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1017\/cem.2016.7","article-title":"Management of bronchiolitis in community hospitals in Ontario: a multicentre cohort study","volume":"18","year":"2016","journal-title":"CJEM"},{"key":"bib70-20230930","doi-asserted-by":"crossref","first-page":"pii: e20170842","DOI":"10.1542\/peds.2017-0842","article-title":"Practice variation in acute bronchiolitis: a pediatric emergency research networks study","volume":"140","year":"2017","journal-title":"Pediatrics"},{"key":"bib71-20230930","first-page":"9730696","article-title":"Predictors of inappropriate use of diagnostic tests and management of bronchiolitis","volume":"2017","year":"2017","journal-title":"Biomed Res Int"},{"key":"bib72-20230930","doi-asserted-by":"crossref","first-page":"67","DOI":"10.1186\/1824-7288-36-67","article-title":"Therapeutic approach to bronchiolitis: why pediatricians continue to overprescribe drugs?","volume":"36","year":"2010","journal-title":"Ital J Pediatr"},{"key":"bib73-20230930","doi-asserted-by":"crossref","first-page":"69","DOI":"10.1016\/j.acap.2014.07.005","article-title":"Variability in inpatient management of children hospitalized with bronchiolitis","volume":"15","year":"2015","journal-title":"Acad Pediatr"}],"container-title":["Pediatric Emergency Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/PEC.0000000000001915","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,30]],"date-time":"2023-09-30T08:18:19Z","timestamp":1696061899000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/PEC.0000000000001915"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,8,30]]},"references-count":72,"journal-issue":{"issue":"9","published-print":{"date-parts":[[2019]]}},"URL":"https:\/\/doi.org\/10.1097\/pec.0000000000001915","relation":{},"ISSN":["1535-1815","0749-5161"],"issn-type":[{"value":"1535-1815","type":"electronic"},{"value":"0749-5161","type":"print"}],"subject":[],"published":{"date-parts":[[2019,8,30]]}}}