Bronchiolitis

Quick Ref Guide

 

Background

  • Bronchiolitis is seasonal (winter) viral lower respiratory tract infection
  • Affects children under 2 years – 1 in 3 infants will develop bronchiolitis
  • 2-3 % all infants with bronchiolitis will require admission to hospital
  • Causes: RSV, rhinovirus, adenovirus, influenza, parainfluenza

Clinical Presentation

  • Nasal Discharge; Wheezy cough; Fever; On auscultation – fine crackles / expiratory wheeze
  • Self-limiting illness
  • Duration depends on severity, causative agent and associated high risk conditions
  • Day 1-2 – viral URTI with coryza
  • Day 2-3 – signs and symptoms of LRTI
  • Day 3-4 – peak of illness
  • Day 5-7 – gradual improvement
  • Cough continues for some weeks

High risk conditions

  • Prematurity
  • Chronic lung disease of prematurity
  • Pre-existing airway problems
  • Congenital cardiac disease
  • Age <2 months
  • Immunodeficiency
  • Neuromuscular disease

What to do

  • Assess severity: (see flow sheet)
  • Hypoxia (<92%): give oxygen immediately
  • MILD – no specific treatment – reassurance, advise small frequent feeds and seek medical advice if poor feeding / increased work of breathing / lethargy. GIVE ADVICE SHEET
  • MODERATE –Refer to Paeds – admit to PAU / ward for observation. If feeding and no further deterioration discharge home (consider phase of illness, social and geographic factors). GIVE ADVICE SHEET
  • SEVERE – Move to Resus, Call for Paediatric Support.Nasal suction if required, Give humidified oxygen. Bronchodilators / Antibiotics / Hypertonic Saline NOT recommended

 

Reference: Guidance for the Management of Bronchiolitis in Children (June 2018)

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