Bibliographic information
GuidelineWHO consolidated guidelines for the management of common childhood illness: management of asthma in children and adolescents and bronchiolitis in infants and young children
Year of Publication2026
Issuing InstitutionWorld Health Organization
Recommendation
New
In infants and children aged less than 2 years, hospitalized with acute bronchiolitis with hypoxaemia, humidified high-flow nasal cannula (HHFNC) oxygen is suggested rather than standard flow oxygen (SFO).
Recommended in favor
Conditional
Certainty of evidence
Low
Notes and Remarks
- In most cases, children with acute bronchiolitis should be started on standard low-flow oxygen, which is very often effective in resolving the hypoxaemia.
- HHFNC oxygen is indicated where, despite standard low-flow oxygen therapy, the infant has persisting hypoxaemia (SpO2 <90%) or severe respiratory distress.
- Ensuring high-quality care and patient safety.
- Regular assessment and monitoring of patient vitals (breathing frequency, heart rate, SpO2), device settings (FiO2, flow), respiratory pattern, breath sounds and comfort level with the device are prerequisites for high-quality care and improved patient safety (207).
- A written protocol specifying the clinical indications and contraindications to guide the initiation and management of patients while on HHFNC therapy should be in place.
- Staff should be trained on the HHFNC protocol, the device, appropriate flow rates according to weight and age, and on regular monitoring of patients. Health system considerations.
- The cost of equipment and personnel required, including training, should be considered.
- Health systems in LMICs are overburdened so there is a need to develop health staff with the appropriate skill mix to support implementation of HHFNC oxygen.