Bronchiolitis

Last Updated on by FRCEM Intermediate

Overview

  • 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

Diagnosis

  • 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

Investigations

  • Clinical

Management

  • 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.

discharge

if Child,

  • 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

  • Apnoea
  • 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

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