Bronchiolitis Clinical Pathway – Inpatient

Inpatient Clinical Pathway for Evaluation/Treatment
of Infants with Bronchiolitis

Goals and Metrics
Patient Education
Provider Resources
  • Supportive Care
    • Suction
    • Hydration, nutrition
    • Supplemental oxygen
    • Pulse oximetry
    • Fever Management
Updated Monitoring Guidance
National guidelines advise against continuous CRM and pulse oximetry monitoring when an infant is not receiving supplemental oxygen or flow.
Infant with Bronchiolitis
Additional Treatment Considerations

Further Diagnostic Testing

 
 
 
 
 
 
 
 
Mild
Moderate
Severe
 
 
 
 
 
 
  • Q4h assessments and pulse oximetry spot checks
  • Nasal suctioning – Bulb
  • Resume normal feeds
 
 
 
 
Weaning
Escalation
  • If mild/moderate assessments x 4 hr, decrease to 1 L/kg/min x 2 hr, then discontinue if remains mild/moderate
  • Discontinue continuous CRM and
    pulse oximetry after 1 hr on room
    air if ≥ 90%
  • Make infant NPO
  • CAT call
  • Consider racemic epinephrine
Discharge Criteria

Response to Intervention Score

    Mild (0) Moderate (1) Severe (2)
RR < 3 mos 30-60 61-80 > 80
3 - < 12 mos 25-50 51-70 > 70
1 yr - 2 yrs 20-40 41-60 > 60
WOB None or mild Intercostal retractions Nasal flaring, grunting, head bobbing
Mental Status Baseline Fussy or anxious Lethargic or inconsolable
Oxygen Requirement None < 1.5 L > 1.5 L
Suctioning Bulb Wall/Bulb Wall
Breath Sounds Clear Crackles, Wheezing Diminished breath sounds or significant crackles, wheezing
Cough Absent or mild Moderate Severe
Posted: November 2013
Revised: August 2025
Editors: Clinical Pathways Team