Viral bronchiolitis Flashcards
What is the age range for children with bronchiolitis?
Age less than 1
3 signature features of viral bronchiolitis
1) Initially coryzal symptoms i.e cough, runny nose, blocked nose
2) Followed by increasing breathlessness
3) Wheeze + crackles on auscultation
Investigations?
Mostly clinical diagnosis
Nasopharyngeal aspirate –> RSV most common (do this if unresponsive to treatment?)
–> send for viral PCR/immunofluorescence/culture
–> for infection control/epidemiological purposes and not for acute Mx
Do not routinely do chest x-ray unless suspect consolidation/ clinically very unwell child
Organisms which cause viral bronchiolitis and which is most common?
RSV (most common)
Adenovirus
Influenza virus
Parainfluenzae virus
Treatment?
Conservative Mx Can give (in order of lowest to highest) 1) O2 2) High-flow O2 3) CPAP 4) Intubation + ventilation
NG tube if having trouble with feeding (if not then IV)
Note: bronchodilators don’t work!
Antibiotics and corticosteroids and chest physio are not proven to work. Doesn’t help in acute Mx or long-term sequelae
Name of Ab treatment?
Pavilizumab
Which target group should Palivizumab be given to?
1) CF patients
2) Premature patients
3) Congenital Heart Disease patients
4) Immunocompromised patients i.e SCID
Given during winter months (monthly injections)
5 signs of respiratory distress in infant?
Cyanosis Tachypnoea Subcostal recessions Intercostal recessions Wheezing Grunting Decreased consciousness (indicates respiratory fatigue) Use of accessory muscles (in the neck) Nasal flaring
Advice for parents with acute bronchiolitis kids at home
Sit child upright so can cough
Make sure child drinks plenty of fluids
No smoking
If signs of respiratory distress –> send to hospital immediately
Factors predisposing to more severe bronchiolitis
1) < 2 months of age
2) Premature patients
3) Congenital Heart Disease patients
4) Chronic lung disease of prematurity
