Bronchiolitis and High Flow Nasal Cannula

Viral bronchiolitis is a leading cause of hospitalization in the first year of life. While supportive care is the mainstay of bronchiolitis management, the medical community continuously searches for treatments to improve patient outcomes. Unfortunately, rigorous studies often fail to detect widespread benefit of these previously promising therapies (e.g., albuterol, steroids).1 The use of one such hopeful therapy, heated and humidified high flow nasal cannula (HFNC), has increased dramatically over the last 10 years both in the ICU and general care area. However, in the same time frame, bronchiolitis admissions have decreased while medical costs and ICU utilization have increased (correlation, not causation!).2-6  

There are now three randomized controlled trials (RCTs) to help evaluate whether HFNC improves bronchiolitis care.7-9The RCTs, which included 1942 patients with moderate bronchiolitis, compared clinical outcomes between patients randomized to early treatment with HFNC to those randomized to early low-flow nasal cannula (LFNC). These studies and a meta-analysis found no difference in clinically meaningful outcomes between early versus late (aka rescue) use of HFNC therapy – including length of stay, ICU utilization, and intubation rates, which were low. The below forest plots from the meta-analysis visually demonstrate this – the bottom diamond crosses the centerline for all measures, indicating no significant difference between early LFNC and early HFNC.10

Car Seat Safety for the Winter Season and Beyond

by Angela Costa, MD

According to the CDC, proper car seat, booster seat and seat belt use can reduce the risk of injury or death by up to 80%. A child younger than 13 is involved in a car crash every 33 seconds. This is why pediatricians and Children’s Injury Prevention Program (CHIPP) feel so strongly about car seat safety. 

Brrrrr… Georgia’s freezing temperatures are here. As winter approaches our patients or even ourselves may have questions about winter coats and car seats. What is the safest way to place our children in the car seat when they’re wearing so many layers? We don’t want them to freeze but is it safe to wear your winter coat in the car seat? The short answer is no. Bulky clothes and jackets can prevent the 5-point harness from fitting properly. While safe kids worldwide does say that we can tightly adjust the harness to better fit over the coat most recommendations state that removing the coat first and laying it over the child after they are properly buckled is the best way to keep them safe. 

With the growing obesity epidemic many may have questions about turning forward facing car seats too soon or advancing to a booster seat while the child is still very young but has “outgrown” the weight for their car seat. The AAP supports the progress and regulatory changes many car seat manufactures face to ensure higher-capacity car seats that can provide the best protection for children. The following was taken from the AAP website: