Bronchiolitis Flashcards
What is bronchiolitis?
characterised by acute bronchiolar inflammation
What is the causing organism?
RSV - main
other causes: mycoplasma, adenoviruses
What age is affected?
most common cause of a serious lower respiratory tract infection in < 1yr olds (90% are 1-9 months, with a peak incidence of 3-6 months)
What protects newborns?
maternal IgG
What are the features?
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
What is often the reason for admission to hospital?
feeding difficulties associated with increasing dyspnoea are often the reason for hospital admission
NICE recommend that clinicians ‘consider’ referring to hospital if any of the following apply:
a respiratory rate of over 60 breaths/minute
difficulty with breastfeeding or inadequate oral fluid
intake (50-75% of usual volume ‘taking account of risk factors and using clinical judgement’)
clinical dehydration.
What are red flags?
apnoea (observed or reported)
child looks seriously unwell to a healthcare professional
severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute
central cyanosis
persistent oxygen saturation of less than 92% when breathing air.
what are the investigations?
immunofluorescence of nasopharyngeal secretions may show RSV
what is the management?
Management is largely supportive:
- humidified oxygen is given via a head box and is typically recommended if the oxygen saturations are persistently < 92%
- nasogastric feeding may be needed if children cannot take enough fluid/feed by mouth
- suction is sometimes used for excessive upper airway secretions
