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- under 2 years of age, peaking between 3 and 6 months
- Respiratory syncytial virus (RSV) is the most common pathogen
- Recovers spontaneously in 2-4 weeks
- Diagnose bronchiolitis if the child has a coryzal prodrome lasting 1 – 3 days, followed by:
- Persistent cough AND
- Either tachypnoea or chest recession (or both) AND
- Either wheeze or crackles on chest auscultation (or both)
High-risk groups for bronchiolitis
- Premature infants
- Cardio-respiratory disease
- Age <3 months
- Give oxygen – if their oxygen saturation is persistently less than 92%.
- Consider continuous positive airway pressure (CPAP) – who have impending respiratory failure.
- Consider upper airway suctioning – who have respiratory distress or feeding difficulties because of upper airway secretions.
- Give fluids by nasogastric or orogastric tube – if they cannot take enough fluid by mouth.
- There is no evidence of benefit from steroids, bronchodilators, or antibiotics.
- is clinically stable.
- is taking oral fluids.
- has maintained oxygen saturation over 92% in air for 4 hours, including a period of sleep.
Indications for admission
- Persistent oxygen saturation of less than 92% on air
- Inadequate oral fluid intake (50 – 75% of usual volume) or no wet nappy for 12 hours
- Persisting severe respiratory distress, for example grunting, marked chest recession or a respiratory rate of over 70 breaths/minute
- Signs of exhaustion, for example, listlessness or decreased respiratory effort