Australasian Bronchiolitis PREDICT Guideline 2025: Evidence-Based Recommendations for Equity and Care Across Diverse Settings

Abstract

Bronchiolitis remains the most common reason for hospitalisation in infants across Australia and Aotearoa New Zealand (AoNZ), particularly during colder months. To address long-standing variation in care and respond to new clinical data, the 2025 Australasian Bronchiolitis Guideline—produced by the Paediatric Research in Emergency Departments International Collaborative (PREDICT) offers timely, evidence-informed recommendations for the management of infants under 12 months of age [1].

Since the original 2016 guideline [2], which aimed to establish consistency across emergency and inpatient settings, research has continued to evolve. The updated 2025 edition is a welcome expansion on the scope to include high-dependency and intensive care management (excluding mechanical ventilation), preventive strategies such as RSV immunoprophylaxis and vaccination, and specific considerations for SARS-CoV-2 co-infection.

The guideline recognises that bronchiolitis care often takes place outside major paediatric centres. As such, it advises clinicians to base decisions on available skills and local resources, not just the physical setting.

Importantly, it also addresses inequities in outcomes. While Indigeneity is not a clinical risk factor, Aboriginal, Torres Strait Islander Peoples, and Māori infants face systemic disadvantages that affect access and outcomes. The guideline emphasises the need for equitable implementation and culturally respectful care.

These recommendations were developed using the GRADE approach (Grading of Recommendations, Assessment, Development, and Evaluation) [3], ensuring a transparent and structured review of the evidence.

This Australasian guideline aligns well with contemporary international guidance. For example, the UK NICE guideline uses similar oxygen thresholds, while the American Academy of Paediatrics (AAP) continues to advocate for the de-implementation of unnecessary treatments [4, 5].

Australasian trials have had direct influence here, particularly in shaping the revised approach to HFNC. Local ICU studies also support the cautious endorsement of corticosteroid–adrenaline therapy in select cases of severe illness.

Further research will determine whether these findings apply across more varied clinical settings.

While the 2025 guideline is comprehensive in its hospital-based scope, it does not address the follow-up of infants once discharged, an area that is explored more directly in other respiratory guidelines, such as those for asthma. The exclusion of post-discharge strategies, including virtual care or remote monitoring, may limit opportunities to support families in the community and potentially reduce avoidable readmissions. These elements may have been outside the scope of the current document, but they represent important directions for future updates as healthcare delivery models evolve.

Some areas of the guideline, such as RSV immunoprophylaxis and viral co-infections, will adopt a ‘living’ format to keep pace with new evidence.

Although designed for hospital use, the recommendations are also relevant for general practitioners, particularly in areas such as diagnosis, discharge planning, and supporting families. Future updates may incorporate long-term outcomes and post-discharge respiratory health.

The 2025 Australasian Bronchiolitis Guideline provides clinicians with a relevant, evidence-based roadmap to enhance care for one of the most common and burdensome conditions in early life. With a strong foundation in local research, international alignment, and a commitment to equity, it represents a major step forward in standardising and improving care across Australia and AoNZ.

Habib Bhurawala conceptualised and wrote the initial draft. Adam Jaffe contributed to the writing and review. Both authors approved the final manuscript.

The authors have nothing to report.

The authors have nothing to report.

A/Professor Habib Bhurawala is a member of the Editorial Board of the Journal of Paediatrics and Child Health. The views expressed in this commentary are those of the authors and do not necessarily reflect those of the journal or Editorial Board. Professor Jaffe declares no conflicts of interest.