Bronchiolitis

Question 1

What is the management of bronchiolitis?

Answer 1

Largely supportive

• Oxygen (humidified if the sats are consistently <92%)
• NG tube if poor feeding (or later IV)
• Suction for excessive airway secretions (not routine)

https://www.nice.org.uk/guidance/ng9/resources/bronchiolitis-in-children-diagnosis-and-management-pdf

Question 2

How can you detect RSV in bronchiolitis?

Answer 2

Nasopharyngeal secretions by immunofluorescence

Question 3

Which symptoms may precede bronchiolitis?

Answer 3

Coryzal symptoms including mild fever

Question 4

What are the features of bronchiolitis?

Answer 4

• Dry cough
• Increasing breathlessness, wheezing, fine inspiratory crackles (not always present)
• Feeding difficulties

Question 5

When (3) should you send a baby with bronchiolitis to hospital?

Answer 5

• RR >60 breaths/minute, marked chest recessions, grunting etc
• poor feeding (50-75% of usual volume)
• dehydration
• O2 <92%

Question 6

When should you admit a baby with bronchiolitis into hospital?

Answer 6

• RR >70/min, respiratory distress
• Apnoea
• Central cyanosis
• Baby looks seriously unwell to HCP

Question 7

How common is bronchiolitis?

Answer 7

1 in 3 babies will develop it in the first year of life and 2-3% will need admission (peak in 3-6 months, because before this maternal IgG protects against infection)

Death is uncommon

higher incidence in winter

Question 8

The development of which condition is bronchiolitis associated with?

Answer 8

Asthma and other chronic respiratory conditions - but not known if it causes these

Question 9

What is the oxygen saturation goal for babies >6 weeks and <6 week with bronchiolitis?

Answer 9

<6 weeks - >90% on room air for 4 hours

>6 weeks or underlying conditions - >92%

Question 10

What safety netting advice can you give to parents with a baby with bronchiolitis?

Answer 10

1. Red flags:
   
   • Increased work of breathing (grunting, nasal flaring, chest recessions)
   • Fluid intake 50% to 75% of normal or no wet nappy for 12hrs
   • Apnoea or cyanosis
   • Exhausion (socially or with stimulation)
2. Do not smoke as it could worsen symptoms of bronchiolitis
3. How to get help from professional
4. Arrange follow up if necessary

Question 11

What % of bronchiolitis is caused by RSV? What other pathogens may cause it?

Answer 11

RSV = 75-80%

Other: mycoplasma, adenoviruses

Question 12

Define bronchiolitis.

Answer 12

Viral acute infection of the lower respiratory tract causing bronchiolal inflammation.

Question 13

What is the use of palivizumab?

Answer 13

This is a monoclonal antibody to prevent RSV infection given as an injection to some infants

Question 14

What are the indications for palivizumab injection?

Answer 14

Given to those an increased risk of RSV:

1. Premature infants
2. Infants with lung or heart abnormalities
3. Immunocompromised infants

Question 15

Describe the duration of bronchiolitis.

Answer 15

Preceded by 2-3 days of coryzal symptoms

Progression to LRTI with wheeze/crepitations

Worst on day 5 then gets better

Overall duration ~10 days

Question 16

What are the risk factors for bronchiolitis?

Answer 16

• Prematurity
• Exposure to tobacco smoke
• Congenital heart disease
• Lung disease e.g. cystic fibrosis
• Immunodeficiency

Question 17

What are the differentials for suspected bronchiolitis?

Answer 17

• Pneumonia
• Viral induced wheeze (if >1yr old)
• Sepsis
• URTI (tonsillitis, otitis media)

Question 18

What is the most common bacterial suprainfection in bronchiolitis?

Answer 18

Staph aureus

Question 19

What should you do first for a baby on the ward in worsening respiratory distress with NG feeding and Optiflow?

Answer 19

STOP NG feeding to prevent feed aspiration