Bronchiolitis

Question 1

What is bronchiolitis? Cause and age group affected?

Answer 1

Inflammation and infection of bronchioles

Most common cause is RSV

Children under 1 year

Question 2

Presentation of bronchiolitis

Answer 2

Coryzal symptoms 
Dyspnoea
Tachypnoea
Signs of respiratory distress - e.g. use of accessory muscles
Poor feeding 
Mild feeding
Apnoea
Wheeze and crackles on auscultation

Question 3

Typical course of RSV bronchiolitis

Answer 3

Symptoms usually last 7-10 days total and most patients fully recover within 2-3w

Symptoms usually worst on days 3-4

Question 4

When to admit in bronchiolitis

Answer 4

Aged under 3 months or any pre-existing condition such as prematurity, Downs syndrome or cystic fibrosis

50 – 75% or less of normal food intake

Clinical dehydration

Respiratory rate above 70

Oxygen saturations below 92%

Moderate to severe
respiratory distress, such as deep recessions or head bobbing

Apnoeas

Question 5

Management of bronchiolitis

Answer 5

Supportive
Ensuring adequate intake -e.g. IV fluids, NG tube
Supplementary oxygen if sats <92%
May need nasal suctioning to clear nasal secretions

Question 6

What can be used as bronchiolitis prophylaxis and when used?

Answer 6

Palivizumab - monthly monoclonal antibody injection that targets RSV

Given to high risk babies - e.g. premature or congenital heart disease