Bronchiolitis

Question 1

Pathophys and Epidiemology of bronchiolitis

Answer 1

Acute bronchiole inflamation - most common in children under 2y/o
RSV is 80% of cases but other viruses can do it -parainfluenza, rhinovirus, adenovirus

2% of children admitted each year-peak in winter and between 3-6m
Maternal IgG protects the child early on

can commonly be found in Co-infection with bacteria

Risk factors:
pre-term/BPD, passive smoking, LBW, hypotonia,
Chronic heart disease- not increase incidence but severity
BREASTFEEDING PROTECTIVE

Question 2

Signs and Sx of Bronchiolitis

Answer 2

Initially - Coryzal Sx (runny nose fever etc)

then–Dry cough, increasing breathlessness, high RR/HR, Low sats

Signs of breathlessness:
grunting,
Subcostal/intercostal recessions, hyperinflation
Expiratory wheeze
Difficulties feeding and drinking -under 50% is bad

auscultate - fine, bi-basal end inspiratory crackles (not always present)

admit on - Signs of Resp distress, Sp02 <92, age <2, eating<50% in 24h, cyanosis/pallor

Question 3

Investigations and Mx of bronchiolitis

Answer 3

Mainly clinical -but can use immunofluorescence to detect RSV in nose

mangement -
mainly supportive -SpO2, ng tube, etc

can give monoclonal Ab for RSV in risky cases -(CHD, preterm, immunodeficient)-palivizumab

self limit in 2 weeks
often has a peak worse then up and up

PACES Counselling:

o Explain diagnosis (common RTI that affects about 1 in 3 children <1 year) a self-limiting over 2 weeks

o Advise maintaining good hydration, using paracetamol if distressed, keeping away from other infants

o Safety net (significant respiratory distress, apnoea)