Bronchiolitis

Question 1

What is bronchiolitis?

Answer 1

Bronchiolitis is a very common chest infection, affecting infants aged 1-12 months.

=> characterised by acute bronchiolar inflammation.

Question 2

What causes bronchiolitis?

Answer 2

Respiratory syncytial virus (RSV) = in 80% of cases

Winter epidemics = higher incidence

Maternal IgG provides protection to newborns against RSV

*very rare for children over 12 months

Question 3

What are the features of bronchiolitis?

Answer 3

Coryzal symptoms (inc. mild fever) precede:

Dry cough

Increasing breathlessness

Wheeze, fine inspiratory crackles (not always present)

Tachypnoea

Intercostal recession, grunting and nasal flaring

Feeding difficulties assoc. with increasing dyspnoea = reasons for hospital admission

Question 4

NICE recommends immediate referral if they have the following bronchiolitis features:

Answer 4

Apnoea (observed or reported)

Child looks seriously unwell to HCP

Severe respiratory distress i.e. grunting, marked chest recession, respiratory rate >70breaths/minute

Central cyanosis

Persistent oxygen sats <92% when breathing air

Question 5

NICE recommends that clinicians consider referring to hospital if the following features of bronchiolitis:

Answer 5

Respiratory rate >60 breaths/min

Difficulty with breast feeding or inadequate oral fluid intake (50-75%) of usual volume ‘taking account of risk factors and using clinical judgement)

Clinical dehydration

Question 6

How is bronchiolitis investigated?

Answer 6

immunofluorescence of nasopharyngeal secretions may show RSV

Question 7

How is bronchiolitis managed?

Answer 7

1. Prophylaxis: Palivizumab in high risk patients
2. Humidified oxygen is given via head box when O2 <92%
3. Nasogastric feeding may be needed if child not taking enough fluid/feed by mouth
4. Suction may be used for excessive upper airway secretions