2.1 Bronchiolitis

Question 1

What are the signs of respiratory distress in kids?

Answer 1

• Raised respiratory rate
• Use of accessory muscles (sternocleidomastoid, abdominal and intercostal muscles)
• Intercostal and subcostal recessions
• Nasal flaring
• Head bobbing
• Tracheal tugging
• Cyanosis (due to low oxygen saturation)
• Abnormal airway noises

Question 2

What causes these abnormal airway noises: wheezing, grunting, stridor?

Answer 2

• Wheezing is a whistling sound caused by narrowed airways, typically heard during expiration
• Grunting is caused by exhaling with the glottis partially closed to increase positive end-expiratory pressure
• Stridor is a high pitched inspiratory noise caused by obstruction of the upper airway, for example in croup

Question 3

Who gets bronchiolitis?

Presentation?

Answer 3

<1y olds in winter (can be in ex-prems up to 2yrs old)

• Coryzal symptoms. Typical Sx of a viral URTI: running or snotty nose, sneezing, mucus in throat and watery eyes.
• Signs of respiratory distress
• Dyspnoea (heavy laboured breathing)
• Tachypnoea (fast breathing)
• Poor feeding
• Mild fever (under 39ºC)
• Apnoeas are episodes where the child stops breathing
• Wheeze and crackles on auscultation

Question 4

What causes / what is happening in bronchiolitis?

Answer 4

Commonly RSV.

Inflammation and mucous narrows the small bronchioles in an infant more than they would in wider adult ones.

–> harsh breath sounds –> wheeze and crackles

Question 5

Typical course of RSV

Answer 5

URTI Sx with coryza then maybe bronchiolitis:

• Half get better spontaneously.
• Half get chest Sx that are worse on day 3 or 4.
• Generally Sx for 7-0 days and fully recover in 2-3 week.
• More likely to get viral induced wheeze in childhood.

Question 6

When do you admit bronchiolitis?

Answer 6

(Most are managed at home)

Admission reasons:
- Aged under 3 months or any pre-existing condition such as prematurity, Downs or CF

• 50 – 75% or less of their normal intake of milk
• Clinical dehydration
• Respiratory rate above 70
• Oxygen saturations below 92%
• Moderate to severe respiratory distress, such as deep recessions or head bobbing
• Apnoeas
• Parents not confident in their ability to manage at home or difficulty accessing medical help from home

Question 7

What is the management of bronchiolitis?

Answer 7

FLUID: adequate oral, NG or IV. Dont overfeed.

SALINE NASAL drops or suctioning can help esp before feeds.

OXYGEN: is sats remain below 92%

VENTILATION if required:

1. high flow humid O2 (Airvo or optiflow) through tight nasal cannula with peep
2. CPAP using sealed nasal cannula, higher and more controlled pressures
3. Intubation and ventilation; endotracheal tube

Asses ventilation using capillary blood gas. (rising pCO2 or falling pH –> type 2 resp failure)

Question 8

What protection can be given to high risk babies to avoid bronchiolitis?

Answer 8

PALIVIZUMAB

Mab against RSV which then activates the immune system
(passive protection, not a vaccine obvs)

Given to: ex-prems and congenital heart disease.