Bronchiolitis

Question 1

Etiology

Answer 1

• Respiratory Syncytial Virus (RSV) – MCC
• Rhinovirus
• Parainfluenza virus type 3

Question 2

Clinical Features

Answer 2

• Prodromal Upper respiratory tract infection symptoms 2-3d with fever, cough, +/- rhinorrhea
• Progressively increasing respiratory distress: tachypnea, retractions, wheezing / hacking cough, inspiratory crackles / expiratory wheeze
• Infants initially appear non toxic but may become progressively lethargic
• Signs of distress: circumoral cyanosis, deepening retractions, audible wheezing
• Hypoxemia in severely affected infants
• Premature infants: apneic spells
• Signs of dehydration may develop due to vomiting and decreased oral intake
• Lasts up to 2 weeks

Question 3

DDX

Answer 3

• Pneumonia
• LTM
• GERD
• FBA
• CHF

Question 4

Measurements

Answer 4

• Weight
• HR
• RR
• Pulse Oximetry

Question 5

Physical Exam Features

Answer 5

Chest Exam:
• Work or breathing: accessory muscle use, nasal flaring, grunting
• Auscultation: wheezing, prolonged expiration, crackles

Question 6

Investigations

Answer 6

• CXR for severe cases -> non specific, patchy, hyperinflation
• NPS swab usually does not alter management
• RSV antigen test of nasal washing for seriously ill children

Question 7

Treatment

Answer 7

• Hydration

* Oxygen Supplementation if sats <90%

Question 8

TREATMENT WITH EQUIVOCAL EVIDENCE:

Answer 8

• Epinephrine Nebulized – not recommended unless severe / ER
• Nasal Suctioning – for comfort
• 3% Hypertonic Saline Nebulization – may be beneficial inpatient, not recommended in ER
• Combined epinephrine / dexa
• Ribavirin no longer recommended except immunosuppressed children with severe RSV infection
• Palivizumab prophylaxis indicated primarily in high-risk infants