Manti etal.Italian Joumal of Pediatrics (2023)49:19Italian Journal of Pediatricshttps:/dol.org/10.1186s13052-022-01392-6REVIEWOpen AccessUPDATE-2022 Italian guidelineson the management of bronchiolitis in infantsSara Manti,Annamaria Staiano2,Luigi Orfeo3,Fabio Midulla,Gian Luigi Marseglia,Chiara GhizzisStefania Zampogna,Virgilio Paolo Camnielli,Silvia Favilli,Martino Ruggieri10,Domenico PerriGiuseppe Di Mauro2,Guido Castelli Gattinara3,Antonio DAvino,Paolo Becherucci5,Arcangelo Prete,Giuseppe Zampino7,Marcello Lanari,Paolo Biban9,Paolo Manzoni2021,Susanna Esposito2,Giovanni Corsello23 and Eugenio Baraldi24*AbstractBronchiolitis is an acute respiratory illness that is the leading cause of hospitalization in young children.This docu-ment aims to update the consensus document published in 2014 to provide guidance on the current best practicesfor managing bronchiolitis in infants.The document addresses care in both hospitals and primary care.The diagnosisof bronchiolitis is based on the clinical history and physical examination.The mainstays of management are largelysupportive,consisting of fluid management and respiratory support.Evidence suggests no benefit with the use ofsalbutamol,glucocorticosteroids and antibiotics with potential risk of harm.Because of the lack of effective treatment,the reduction of morbidity must rely on preventive measures.De-implementation of non-evidence-based interven-tions is a major goal,and educational interventions for clinicians should be carried out to promote high-value careof infants with bronchiolitis.Well-prepared implementation strategies to standardize care and improve the qualityof care are needed to promote adherence to guidelines and discourage non-evidence-based attitudes.In paral-lel,parents'education will help reduce patient pressure and contribute to inappropriate prescriptions.Infants withpre-existing risk factors(i.e.,prematurity,bronchopulmonary dysplasia,congenital heart diseases,immunodeficiency,neuromuscular diseases,cystic fibrosis,Down syndrome)present a significant risk of severe bronchiolitis and shouldbe carefully assessed.This revised document,based on international and national scientific evidence,reinforces thecurrent recommendations and integrates the recent advances for optimal care and prevention of acute bronchiolitis.Keywords Bronchiolitis,Guidelines,Infants,Respiratory syncytial virus,Update,PreventionIntroductionfrom mild to severe respiratory distress and potentiallyViral bronchiolitis is the most frequent lower respiratoryculminating in acute respiratory failure [1].tract infection and the leading cause of hospitalizationThe most common causative agent is Respiratory Syn-and death in infants less than twelve months of age [1].cytial Virus(RSV);it has been estimated that RSV infectsClinically,infants with bronchiolitis may experience amore than 60%of all children during the first year of life,wide range of non-specific signs and symptoms,rangingand that RSV infects nearly all chil
