European Journal of Pediatrics

, Volume 178, Issue 3, pp 331–340 | Cite as

Nutritional management of young infants presenting with acute bronchiolitis in Belgium, France and Switzerland: survey of current practices and documentary search of national guidelines worldwide

  • Frédéric V. VallaEmail author
  • Florent Baudin
  • Pierre Demaret
  • Shancy Rooze
  • Clémence Moullet
  • Jacques Cotting
  • Carole Ford-Chessel
  • Robin Pouyau
  • Noël Peretti
  • Lyvonne N. Tume
  • Christophe Milesi
  • Bénédicte Gaillard Le Roux
Original Article


Feeding difficulties are common in young infants presenting with acute bronchiolitis, but limited data is available to guide clinicians adapting nutritional management. We aimed to assess paediatricians’ nutritional practices among Western Europe French speaking countries. A survey was disseminated to describe advice given to parents for at home nutritional support, in hospital nutritional management, and preferred methods for enteral nutrition and for intravenous fluid management. A documentary search of international guidelines was concomitantly conducted. Ninety-three (66%) contacted physicians responded. Feeding difficulties were a common indication for infants’ admission. Written protocols were rarely available. Enteral nutrition was favoured most of the time when oral nutrition was insufficient and might be withheld in case of severe dyspnoea to decrease respiratory workload. Half of physicians were aware of hyponatremia risk and pathophysiology, and isotonic intravenous solutions were used in less than 15% of centres. International guideline search (23 countries) showed a lack of detailed nutritional management recommendations in most of them.

Conclusion: practices were inconsistent among physicians. Guidelines detailed nutritional management poorly. Awareness of hyponatremia risk in relation to intravenous hypotonic fluids and of the safety of enteral hydration and nutrition is insufficient. New guidelines including detailed nutritional management recommendations are urgently needed.

What is Known?

• Infants presenting with acute bronchiolitis face feeding difficulties.

• Underfeeding may promote undernutrition, and intravenous hydration with hypotonic fluids may induce hyponatremia.

What is New?

• Physicians’ nutritional practices are inconsistent and awareness of hyponatremia risk and pathophysiology is insufficient among physicians.

• Awareness of hyponatremia risk and pathophysiology is insufficient among physicians.

• The reasons for enteral nutrition withholding in bronchiolitis infants are not evidence based, and national guidelines of acute bronchiolitis across the world are elusive regarding nutritional management.

• National guidelines of acute bronchiolitis across the world are elusive regarding nutritional management.


Recommendation Child Nutrition Bronchiolitis, clinical practice 





the French speaking paediatric intensive care nutrition group


paediatric intensive care units


syndrome of inappropriate secretion of antidiuretic hormone



We would like to thank all the physicians who responded to the survey, from a wide panel of paediatric units (Switzerland: Morges, Aigle, Yverdon, Nyon. Belgium: Liège, Libramont, Huy, Marche, Malmedy, Namur, Bruxelles, Ixelles, Mons, Hornu. France: Marseille, Nîmes, Bézier, Carcassonne, Perpignan, Ales, Mende, Narbonne, Montpellier, Nantes, La Rochelle, Tours, Angers, Rennes, Chateaubriand, Caen, Brest, Bordeaux, Périgueux, vannes, Le Mans, Morlaix, Paris, La Roche-sur-Yon, Saint Denis, Argenteuil, Paris, Pontoise, Lyon, Bourg en Bresse, Lons le Saulnier, Oyonnax, Belley, Annemasse, Chalon-sur-Saône, Macon, Villefranche-sur-Saône, Montbrison, Firminy, St Etienne, Vienne, Bourgoin-Jailleux, Chambéry, Sallanches, Annecy, Thonon les Bains, Romans-sur-Isère, Valence, Montélimar, Annonay, Voiron, Grenoble, Clermont-Ferrand, Vichy, Aurillac, Vaulx-en-Velin).

Authors’ contributions

FVV, BGLR, CFC and LNT conceived the idea for this paper, undertook the literature search and worked on the review and manuscript. LNT edited the English wording.

PD, SR, CM, JC, CM, RP tested the survey, disseminated the survey and helped analysing the results.

FB and NP critically reviewed the results and the manuscript.

Compliance with ethical standards

Ethical approval was obtained for the study (Hospices Civils de Lyon ethical committee 18/07/2017).

This paper complies with ethical standards.

Informed consent was implicit for surveyed physicians upon response to the survey.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

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ESM 1 (DOCX 37 kb)
431_2018_3300_MOESM2_ESM.docx (34 kb)
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ESM 3 (DOCX 41 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Frédéric V. Valla
    • 1
    • 2
    • 3
    Email author
  • Florent Baudin
    • 1
    • 4
  • Pierre Demaret
    • 5
  • Shancy Rooze
    • 6
  • Clémence Moullet
    • 7
  • Jacques Cotting
    • 8
  • Carole Ford-Chessel
    • 1
    • 9
  • Robin Pouyau
    • 1
  • Noël Peretti
    • 3
    • 10
  • Lyvonne N. Tume
    • 2
    • 11
  • Christophe Milesi
    • 12
  • Bénédicte Gaillard Le Roux
    • 13
  1. 1.Paediatric Intensive CareHôpital Femme Mère Enfant, Hospices Civils de LyonLyon-BronFrance
  2. 2.Faculty of Health and Applied SciencesThe University of the West of EnglandBristolUK
  3. 3.CarMEN INSERM UMR 1060 Equipe INFOLIPVilleurbanneFrance
  4. 4.Université Claude Bernard Lyon 1LyonFrance
  5. 5.Division of Paediatric Critical Care Medicine, Department of PaediatricsCHCLiègeBelgium
  6. 6.Paediatric Intensive CareHôpital Universitaire des Enfants Reine FabiolaLaeken-BrusselsBelgium
  7. 7.Department of Nutrition and Dietetics, Haute Ecole de SantéUniversity of Applied Sciences of Western SwitzerlandCarougeSwitzerland
  8. 8.Paediatric Intensive CareUniversity Hospitals of LausanneLausanneSwitzerland
  9. 9.Paediatric Nutrition and Dietetic DepartmentHôpital Femme Mère Enfant, Hospices Civils de LyonLyon-BronFrance
  10. 10.Paediatric Gastroenerology and Nutrition DepartmentHôpital Femme Mère Enfant, Hospices Civils de LyonLyon-BronFrance
  11. 11.Paediatric Intensive Care UnitBristol Children’s HospitalBristolUK
  12. 12.Paediatric Intensive CareHôpital Arnaud de VilleneuveMontpellierFrance
  13. 13.Paediatric Intensive CareHôpital Femme Mère EnfantNantesFrance

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