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Protocol and Guidelines for Point-of-Care Lung Ultrasound in Diagnosing Neonatal Pulmonary Diseases Based on International Expert Consensus
Published on: March 6, 2019
[Chest X-ray and acute bronchiolitis: Are these indications decreasing?]
Insights
A new protocol significantly reduced chest X-rays for infant bronchiolitis but many remain unnecessary. This led to increased antibiotic use for suspected pneumonia, highlighting a need for better adherence to guidelines.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Diagnostic Imaging
Background:
- Acute bronchiolitis is a common respiratory infection in infants.
- Chest X-rays are recommended for bronchiolitis only when clinical course is unusual or differential diagnosis is suspected.
- A management protocol was implemented to guide X-ray use in 2012.
Purpose of the Study:
- To evaluate professional practices regarding chest X-ray use in infants hospitalized with acute bronchiolitis after protocol implementation.
- To assess adherence to the established management protocol for diagnostic imaging.
Main Methods:
- Retrospective descriptive study.
- Inclusion of infants aged 0-23 months hospitalized for their first acute bronchiolitis episode.
- Data collected from October 2013 to March 2015 across two pediatric units.
Main Results:
- 599 infants were included; 59.3% had at least one chest X-ray, a 38.5% decrease from 2012.
- X-rays were abnormal in 96.3% of cases, showing common findings like distension and thickening.
- 42.5% of X-rays were performed outside protocol recommendations, leading to increased antibiotic prescriptions for pneumonia.
Conclusions:
- The management protocol successfully decreased chest X-ray utilization in acute bronchiolitis.
- Suboptimal adherence to guidelines resulted in unnecessary X-rays and increased antibiotic use.
- Further efforts are needed to ensure appropriate diagnostic imaging and antibiotic stewardship in infant bronchiolitis management.
Objective:
A management protocol for infants hospitalized for acute bronchiolitis, established after the study conducted in our unit in 2012, recommends a chest X-ray when the clinical course is unusual or if a differential diagnosis is suspected. The goal of this study was to evaluate professional practices after the introduction of this new management protocol.
Study Design:
Retrospective descriptive study in two pediatric units from October 2013 to March 2015, including infants (0-23 months) hospitalized for their first episode of acute bronchiolitis without any underlying chronic condition.
Result:
Overall, 599 infants were included (median age, 3.7 months, 54 % boys). Nearly six out of ten (n=355, 59.3 %) had at least one chest radiograph (38.5 % fewer than in 2012). It was abnormal in 96.3 % of cases, revealing distension and/or bronchial wall thickening (56.7 %), focal opacity (23.5 %), or atelectasis (19.5 %). An X-ray was performed out of the recommendations in 42.5 % of cases. The chest X-ray result led to management changes in 52 infants with prescription of antibiotics for pneumonia (86.5 %) and allowed the diagnosis of heart disease in one case (0.2 %). Management of acute bronchiolitis (X-ray and antibiotics) was statistically different between the two pediatric units.
Discussion:
This protocol led to a significant decrease in the number of chest X-rays. However, many are still performed out of the recommendations, resulting in an increase of antibiotic use for pneumonia.
Conclusion:
The decrease in use of chest X-rays in acute bronchiolitis for hospitalized infants was significant but remains insufficient.
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