Flashcards in Bronchiolitis: Recommendations for diagnosis, monitoring and management of children one to 24 months of age Deck (19):
What is bronchiolitis?
Viral lower respiratory tract infection characterized by obstruction of small airways caused by acute inflammation, edema, and necrosis of the epithelial cells lining the small airways as well as increased mucus production
What viruses cause bronchiolitis?
1. RSV (most common)
7. Multiple viruses 10-30%
What is the prevalence of bronchiolitis?
1/3 of children in the 1st 2y of life. 3% of all infants are hospitalized
What is the most common cause of admission to hospital in the first year of life?
What are the symptoms and signs of viral bronchiolitis?
1. Preceding viral URTI, cough and/or rhinorrhea
2. Exposure to individual w/ viral URTI
4. Intercostal and/or subcostal retractions
5. Accessory muscle use
6. Nasal flaring
8. Colour change or apnea
9. Wheezing or crackles
10. Lower O2 saturations
What is the differential diagnosis for wheezing in young children?
1. Viral bronchiolitis
3. Other pulmonary infections e.g. pneumonia
5. Foreign body aspiration
7. Congestive heart failure
8. Vascular ring
9. Allergic reaction
10. Cystic fibrosis
11. Mediastinal mass
12. Tracheoesophageal fistula
What diagnostic studies are recommended in bronchiolitis?
1. CXR only if severity or course suggests alternate diagnosis
2. Nasopharyngeal swab only if required for cohorting admitted patients
3. CBC generally not helpful in routine cases
4. Blood gas only if concerned about potential respiratory failure
5. BCx not recommended routinely, maybe required based on clinical findings and a child's age
What groups are at higher risk for severe disease?
1. Infants born prematurely <35wks GA
2. <3mo at presentation
3. Hemodynamically significant cardiopulmonary disease
What are the guidelines for admission?
1. Signs of severe respiratory distress (indrawing, grunting, RR>70)
2. Supplemental O2 required to keep sats >90%
3. Dehydration or history of poor fluid intake
4. Cyanosis or history of apnea
5. Infant at high risk for severe disease
6. Family unable to cope
What interventions are recommended?
What interventions have equivocal evidence?
1. Epinephrine nebulization
2. Nasal suctioning
3. 3% hypertonic saline nebulization
4. Combines epinephrine and dexamethasone
What interventions are not recommended?
5. Cool mist therapies or therapy with saline aerosol
6. Chest physiotherapy
What are indications for discharge from hospital?
1. Tachypnea and work of breathing improved
2. Maintain O2 sats >90% without supplemental oxygen OR stable for home oxygen therapy
3. Adequate oral feeding
4. Educations provided and appropriate follow-up arranged
What measures of hydration are effective?
NG hydration is equally effective as IV hydration
Which patients should have continuous CRM?
Those with previous apneic episode or young age (<1m or <48 wks post-conception in premature infants)
Which patients should have continuous saturation monitoring?
High risk patients early in the course of disease
Which patients should have intermittent saturation monitoring?
Lower risk patients
All patients once they are feeding well, weaned from supplemental O2 and showing improvements in WOB
What are the recommendations for IV hydration?
Isotonic solution is recommended (0.9%NaCl/5% dextrose) with routine monitoring for serum Na