Nutritional management of young infants presenting with acute bronchiolitis in Belgium, France and Switzerland: survey of current practices and documentary search of national guidelines worldwide

• DOI: 10.1007/s00431-018-3300-1
• Publication Date: 2018-12-01T15:28:02Z
• Authors: Frédéric V. Valla; Florent Baudin; Pierre Demaret; Shancy Rooze; Clémence Moullet; Jacques Cotting; Carole Ford-Chessel; Robin Pouyau; Noël Peretti; Lyvonne N. Tume; Christophe Milesi; Bénédicte Gaillar...
• Keywords: Nutritional Support/adverse effects/*methods/statistics & numerical data; [SDV]Life Sciences [q-bio]; Practice Patterns; Fluid Therapy/adverse effects/methods/statistics & numerical data; 618; 03 medical and health sciences; 0302 clinical medicine; Belgium; 616; Humans; Centre for Health and Clinical Research; Practice Patterns, Physicians'; Child; Nutrition; 2. Zero hunger; Nutritional Support; feeding, bronchiolitis, guidelines, infants, survey; Infant, Newborn; Infant; Recommendation; Bronchiolitis/*therapy; Newborn; clinical practice; 3. Good health; Cross-Sectional Studies; Health Care Surveys; Acute Disease; Practice Guidelines as Topic; Bronchiolitis; Fluid Therapy; Physicians'/*statistics & numerical data; France; Switzerland

Feeding difficulties are common in young infants presenting with acute bronchiolitis, but limited data is available to guide clinicians adapting nutritional management. We aimed to assess paediatricians' nutritional practices among Western Europe French speaking countries. A survey was disseminated to describe advice given to parents for at home nutritional support, in hospital nutritional management, and preferred methods for enteral nutrition and for intravenous fluid management. A documentary search of international guidelines was concomitantly conducted. Ninety-three (66%) contacted physicians responded. Feeding difficulties were a common indication for infants' admission. Written protocols were rarely available. Enteral nutrition was favoured most of the time when oral nutrition was insufficient and might be withheld in case of severe dyspnoea to decrease respiratory workload. Half of physicians were aware of hyponatremia risk and pathophysiology, and isotonic intravenous solutions were used in less than 15% of centres. International guideline search (23 countries) showed a lack of detailed nutritional management recommendations in most of them.Conclusion: practices were inconsistent among physicians. Guidelines detailed nutritional management poorly. Awareness of hyponatremia risk in relation to intravenous hypotonic fluids and of the safety of enteral hydration and nutrition is insufficient. New guidelines including detailed nutritional management recommendations are urgently needed. What is Known? • Infants presenting with acute bronchiolitis face feeding difficulties. • Underfeeding may promote undernutrition, and intravenous hydration with hypotonic fluids may induce hyponatremia. What is New? • Physicians' nutritional practices are inconsistent and awareness of hyponatremia risk and pathophysiology is insufficient among physicians. • Awareness of hyponatremia risk and pathophysiology is insufficient among physicians. • The reasons for enteral nutrition withholding in bronchiolitis infants are not evidence based, and national guidelines of acute bronchiolitis across the world are elusive regarding nutritional management. • National guidelines of acute bronchiolitis across the world are elusive regarding nutritional management.