Bronchiolitis

Question 1

Common aetiologies of bronchiolitis

Answer 1

RSV is pathogen in 75-80% of cases

Other causes include mycoplasma, adenoviruses

May be secondary bacterial infection

Question 2

Clinical features of bronchiolitis

Answer 2

Coryzal symptoms (including mild fever) precede:

Dry cough

Increasing breathlessness

Wheezing, fine inspiratory crackles (not always present)

Feeding difficulties associated with increasing dyspnoea are often the reason for hospital admission

Question 3

Signs of respiratory distress

Answer 3

Raised respiratory rate

Use ofaccessory musclesof breathing, such as SCM,abdominalandintercostalmuscles

Intercostalandsubcostal recessions

Nasal flaring

Head bobbing

Tracheal tugging

Cyanosis(due to low sats)

Abnormal airway noises

Question 4

Investigations in bronchiolitis

Answer 4

Immunofluorescence of nasopharyngeal secretions may show RSV

Question 5

Management of bronchiolitis

Answer 5

Largely supportive

Humidified oxygen given via a head box (typically recommended if sats persistently <92%)

NG feeding may be needed

Suction is sometimes used for excessive upper airway secretions

Ventilation may be required

Question 6

Bronchiolitis immediate referral

Answer 6

Apnoea

Child looks seriously unwell

Severe respiratory distress

Resp rate >70

Central cyanosis

Persistent sats <92% OA

Question 7

Bronchiolitis consider referral

Answer 7

Resp rate >60

Difficulty breastfeeding or inadequate oral intake

Clinical dehydration

Question 8

Bronchiolitis prevention

Answer 8

For high risk babies (ex-premature, CHD)

Palivizumab is monoclonal antibody that targets RSV

Monthly injection