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NICE issues draft guidance on common infant breathing disorder

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The National Institute for Health and Care Excellence has issued draft recommendations to provide best practice advice on the care of babies and young children with bronchiolitis.

The draft guidance highlights the importance of accurate diagnosis as well as setting out “red flags” for when the condition may be more serious and how to treat it.

“Bronchiolitis may often be confused with a common cold in infants who present to primary care”

Mark Baker

Bronchiolitis is the most common disease that affects the lower respiratory tract and around one in three babies will develop the condition in their first year of life.

Symptoms usually start as a cough with forced breathing and it often results in difficulty feeding.

Professor Mark Baker, director of clinical practice at NICE, said: “Bronchiolitis may often be confused with a common cold in infants who present to primary care.

“It is very important that children with bronchiolitis are correctly diagnosed and their symptoms closely monitored,” he said. “So parents and carers, as well as doctors, nurses and health visitors need to know when to seek help from specialist care.”

Mark Baker

Mark Baker

Most children with bronchiolitis can be managed at home and the draft guideline has key safety information for parents and carers.

This includes “red flag” symptoms to look out for such as increasing difficulty breathing or exhaustion, and when to arrange a follow up or get immediate help.

A small proportion, around 2-3%, of infants with bronchiolitis will require hospitalisation.

The guideline sets out recommendations for people working in primary care on when to consider referral to specialist care, such as if a child has rapid breathing – a respiratory rate of over 60 breaths/minute – difficulty breastfeeding or clinical dehydration.

It also sets out the symptoms which require immediate referral to emergency care – including stopping breathing, looking seriously unwell or beginning to turn blue.

The draft recommends treatment with supportive therapies such as oxygen, airway suctioning or tube feeding for some children with bronchiolitis. It does not recommend the use of a range of other therapies such as antibiotics, bronchodilators or corticosteroids.

The draft guideline will be open for public consultation till 5 January 2015. Individuals are advised to pass comments through the registered stakeholder organisation that most closely represents them.

The final guideline is due to be published in May 2015.

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