Survey of Practice Variations in Management of Acute Viral Bronchiolitis in India (PRERNI-PAVB Survey)
Sahil Vikas1, Suresh K Angurana1, Jayashree Muralidharan1
1Division of Pediatric Critical Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Background And Aims:
To identify the practice variations in the management of acute viral bronchiolitis (AVB) in different healthcare settings across India.
Methods:
This online survey was conducted over 2½ months (May-July 2025) involving healthcare professionals (pediatricians, emergency physicians, and pediatric intensivists) working in different healthcare settings in India. Questions were related to demographic profile, caseload and seasonal variations, diagnosis, admission/discharge criteria, and treatment.
Results:
Among 100 respondents across 21 states/union territories, the majority were pediatric intensivists (n = 55) and pediatricians (n = 30) working in tertiary-level hospitals (n = 90). The pediatric intensive care unit (PICU) was available to 88 respondents. Most respondents diagnose AVB in children <2 years (n = 66) based on clinical history and examination alone (n = 41) and the addition of chest radiograph (n = 44). Common investigations performed among admitted children were chest radiograph (n = 76), sepsis screen (n = 64), and viral polymerase chain reaction (n = 47). Common admission criteria were high-risk babies (n = 94), severe respiratory distress (n = 91), doubtful follow-up (n = 72), and SpO2 <94% (n = 50). Once admitted, most respondents measure SpO2 intermittently (n = 59), start oxygen therapy if SpO2 <94% (n = 52), and maintain SpO2 >92% during treatment (n = 49). Once off oxygen, SpO2 >94% was used as a threshold to discharge (n = 58). Common modes to start oxygen were simple nasal prongs (n = 75) and high-flow nasal cannula (n = 58). The majority (n = 96) use nebulizations, including 3% saline (n = 86) and adrenaline (n = 52). Antibiotic use was reported by most as sometimes or rarely (n = 87). Most respondents use either the Indian Academy of Pediatrics (n = 48) or the American Academy of Pediatrics (n = 25) guidelines, and only 36 have a written policy/flowchart in the unit for management of AVB.
Conclusion:
We noted wide variations in the diagnosis, severity assessment, investigations, treatment, and adherence to guidelines for AVB. However, the majority of respondents use antibiotics sometimes or rarely.
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