Last Updated on January 26, 2019 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