Bronchiolitis Flashcards
What is bronchiolitis?
Inflammation and infection of the bronchioles (small airways) causing an obstruction to airflow in infants.
What is the most common cause of bronchiolitis?
Viruses
Particularly Respiratory Syncytial Virus (RSV)
When does bronchiolitis occur?
Babies up to 1 year old
Most common up to 6 months
Rarely in children up to 2 who were premature babies and have chronic lung disease.
What is found on auscultation of the chest in an infant with bronchiolitis?
Harsh breath sounds, wheeze and crackles.
What is the presentation in bronchiolitis?
Coryzal symptoms,
-runny/snotty nose
-sneezing
-mucus in throat
-watery eyes
Respiratory distress
-dyspnoea
-tachypnoea
-poor feeding
-mild fever
-apnoea
What are the signs of respiratory distress?
Raised respiratory rate
Use of accessory muscles
Intercostal and subcostal recessions
Nasal flaring
Head bobbing
Tracheal tugging
Cyanosis
Abnormal airway noises
What are some abnormal airway noises?
Wheezing (narrow airways, expiration)
Grunting (exhaling with glottis partially closed)
Stridor (high pitched inspiratory noise)
What is the typical course of bronchiolitis?
Starts with coryzal symptoms
Chest symptoms at day 1-2
Symptoms at their worst on day 3 or 4
Symptoms last 7-10 days
What is the criteria for admission?
Reasons include:
Children under 3 months or with a pre existing condition
50-75% of less of their normal milk intake
Clinically dehydrated
Respiratory rate >70
Oxygen saturation less than 92%
Moderate to severe respiratory distress
Apnoeas
Parents concerned
What is the management of bronchiolitis?
Supportive mostly
Ensure adequate intake of fluid (either orally, via NG tube, IV fluids)
Avoid over feeding
Saline nasal drops or suction
Supplementary oxygen
Ventilators support maybe
What are the steps in ventilators support?
- High flow humidified oxygen
- CPAP
- Intubation and ventilation
What is palivizumab?
Monoclonal antibody targeting RSV
Preventative measure for high risk babies and those with congenital heart problems
