6.3 Bronchiolitis, Pneumonia, Pertussis

Question 1

Bronchiolitis

Answer 1

• Inflammation and congestion of bronchioles in lower respiratory tract
• Viral infection (most commonly caused by RSV and spread through direct contact)
• CONTACT/DROPLET PRECAUTIONS
• Most common in winter/early spring
• VERY SERIOUS IN CHILDREN LESS THAN 2
• 95% of kids have had this by age 3

Question 2

Bronchiolitis Pathology

Answer 2

• Bronchioles swell and become filled with fluid/mucous causing airways to become more narrow and possible obstruction
• Patches of atelectasis
• Hyperinflation
• Air becomes trapped in lower airways
• Can cause hypoventilation which leads to respiratory acidosis

Question 3

Bronchiolitis Manifestations

Answer 3

Days 1-3
- Normal URI with small fever
- No big deal (symptoms similar to cold)

Days 3-5
- MUCH MORE PROMINENT
- Tachypnea, severe retractions, significant coughing, crackles, diminished breath sounds, wheezing
- Supplemental oxygen is given, IV fluids, sometimes NG tubes (due to breathing too quick to give formula/breast feed)
- This can progress to pneumonia

TREATMENT
- Supportive care because it is a viral infection
- O2, Hydration, Antipyretics, Suction Secretions, Monitor O2 Sat, Inhalation Medications.
- Most can be managed at home with rest, fever control, and fluid control. Look out for decreased urinary output, increased work of breathing
- X-rays to see how the lungs look
- Cultures to confirm RSV is the cause
- RESPIRATORY DISTRESS AND DEHYDRATION IS MOST IMPORTANT

IF CHILD IS LESS THAN 2
- Hospitalization is necessary

MEDICATION
- Ribavirin (specific anti-viral for bronchiolitis)
- Antibiotics only if secondary bacterial infection is apparent
- Oxygen
- Bronchodilators
- Palivizumab - Vaccine approved for children born premature (before 29 weeks) or with chronic lung disease due to prematurity

Question 4

Pneumonia

Answer 4

• Classified based on location and causative agent
• Viral, bacterial, mycoplasma, aspiration

Aspiration Pneumonia - Does not require infection precautions or PPE

Symptoms
- Fluid is filling alveolar sack
- VERY HIGH FEVER
- Tachypnea, increased work of breathing, crackles, diminished breath sounds.
- Irritable, restless, lethargic, anorexia
- Chest/Abdomen Pain

DIAGNOSIS
- Chest radiograph and CBC with x-rays and WBC count for infection

TREATMENT
- Hospitalized when they are dehydrated, worried about respiratory distress, when medications don’t work, or worried about pleural effusion.
- Treatment depends on the cause
- IV Fluids

Bacterial - Antibiotics
Viral - Supportive Care (fever management and adequate rest)

Question 5

Pertussis (Whooping Cough)

Answer 5

• Usually in kids under 4
• Highly contagious caused by bacteria Bordetella Pertussis

Symptoms
- Apnea in children less than 6 months old (because they cannot expel mucus)
- TERRIBLE COUGH FROM 6-10 WEEKS
- MINUTES OF COUGHING AND THEY CANNOT STOP
- Typically happens in spring-summer

Other symptoms (severe)
- Pneumonia
- Rib fractures (from significant cough)
- Bleeding conjunctiva
- Encephalopathy
- Seizure/Death

PREVENTION
- TDAP/DTAP Vaccine