Bronchiolitis Flashcards
Define bronchiolitis
Acute viral infection of the lower respiratory tract
What is the aetiology of bronchiolitis
Respiratory Syncytial virus (RSV) is the most common
Rhinovirus
Human bocavirus
Adenovirus
What are the risk factors for bronchiolitis
Time of year: October-March (Winter seasonality)
Infants <1 yo
Smoke exposure
Environmental pollutants
Prematurity
Bronchopulmonary dysplasia
Impaired airway clearance and function
Congenital heart disease
Immunodeficiency
What are the symptoms of bronchiolitis
Prodrome of coryzal symptoms
Persistent cough
May be wet or dry
Audible wheeze on breathing
Fever (usually <39)
Poor feeding (typically day 3-5)
Infant suddenly turns blue (apnoea)
Irritability, malaise
Give some differentials for bronchiolitis
Pneumonia
Cystic fibrosis
Croup
Asthma
What are the signs of bronchiolitis on examination
Fluctuating clinical findings
Signs of respiratory distress:
Chest recessions
Cyanosis
Tachypnoea >60
Accessory muscle use
Thoracoabdominal asynchrony
Dehydration:
prolonged CRT
Poor skin turgor
Dry mucous membranes
General
Agitation
Loss of consciousness
Signs of exhaustion
Cyanosis (blue lips/skin, pale/mottled/ashen tinge)
Respiratory
Involvement of accessory muscles for respiratory
Wheeze
Fine crackles
Hyperinflation
What investigations are done for bronchiolitis
Clinical diagnosis (investigations not required)
bedside: sats, nasal swab (influenza, COVID, RSV)
Bloods: ELISA, PCR
CXR: hyperinflation, inflammation
What is the management of mild bronchiolitis
Supportive - does not require admission
Advise:
self-limiting illness
Symptoms will be the worst on day 3-5
Paracetamol/ibuprofen can be used for fever
Do NOT under-dress the child or use tepid sponging
Ensure adequate fluid intake
+ safety net
What safety netting should be given for bronchiolitis
Check on the child regularly, including through the night. Seek help if:
Breathing rate increases
Any episodes of apnoea
Signs of increased effort of breathing
Baby takes <50% of normal feeds
Signs of dehydration: dry mouth, infrequent passage of urine
Baby becomes less responsive or difficult to rouse
Persistent worsening of fever
What features would suggest need for admission for bronchiolitis
Apnoea (observed or reported)
Child looks seriously unwell
Severe respiratory distress e.g. grunting, marked chest recession, RR >70/min
Requires feeding support (dehydrated, tolerating <50% of feeds)
Central cyanosis
Sats <92%
What is the management of severe bronchiolitis
Oxygen supplementation
IV fluids
NG tube feeds
What can be used for bronchiolitis prophylaxis and when is it indicated
Palivizumab IM one monthly during RSV season
Given to those with a high risk of severe RSV infection (Chronic lung disease, congenital heart disease, neuromuscular disorders, <3 months, premautrity)
What are the complications of bronchiolitis
Bacterial pneumonia
Recurrent wheeze (prevalence decreases at 13yo)
Paediatric asthma
What is the prognosis for bronchiolitis
For most infants the disease is self-limiting, typically lasting for 3–7 days.
The cough resolves within 3 weeks
Associated with an increased risk of chronic respiratory conditions e.g. asthma
