Bronchiolitis

Question 1

What is the commonest acute LRTI in infancy?

Answer 1

Bronchiolitis

Question 2

What is bronchiolitis?

Answer 2

Viral infection of the lower respiratory tract that affects the bronchioles and alveoli.

Question 3

What is the main cause of bronchiolitis?

Answer 3

Respiratory syncytial virus

Question 4

What is this a presentation of?
Worsening of symptoms up to day 5 followed by a gradual improvement and resolution at day 10, cough resolves later.
Coryza land rhinorrhoea prodrome, followed by more persistent cough, wheeze, tachypnoea, bilateral inspiratory crackles , fever, reduced feeding.

Answer 4

Bronchiolitis

Question 5

What are the risk factors for bronchiolitis?

Answer 5

Under 3 months of age history of apnoea, prematurity, cardiac disease, long disease, immunodeficient, neuromuscular disease.

Question 6

How is bronchiolitis diagnosed?

Answer 6

1. Clinical
2. Nasal pharyngeal aspirate to swab for RSV
3. CXR to exclude pneumonia or pneumothorax
4. FBC, blood gas, SpO2

Question 7

What is the management for bronchiolitis?

Answer 7

1. Supportive
2. Admit if signs of severe respiratory distress.
3. Oxygen if hypoxic
4. Hypertonic saline if very ‘coughy’
5. Small amounts of feed through an NG tube if feeding <50%

Question 8

When should you intubate a child with bronchiolitis?

Answer 8

If <90% sats despite maximal optiflow, respiratory acidosis pH <7.2, recurrent apnoea.