Bronchiolitis

Question 1

Define Bronchiolitis

Answer 1

infection/inflammation of the (bronchioles) small airways in the lungs

Question 2

Bronchiolitis most common causative virus

Answer 2

Respiratory Syncytial Virus (RSV)

Question 3

RSV bronchiolitis risk factors

Answer 3

• infant under 6months
• pre-termed children
• long-term heart/lung conditions
• Expose to smoke

Question 4

At what age is RSV most common in children

Answer 4

infant under 6 months

Question 5

bronchiolitis presentations

Answer 5

• Coryzal symptoms (runny nose, sneezing, watery eyes)
• Low-grade fever (under 39ºC)
• Nasal congestion
• Feeding difficulty
• Tachypnoea
• Apnoeas (episodes where the child stops breathing)

Question 6

List 3 abnormal airway noises

Answer 6

• Wheeze
• Grunting
• Stridor

Question 7

what causes a wheeze

Answer 7

Narrowed airways usually heard during expiration

Question 8

what causes grunting

Answer 8

Exhaling with partially closed glottis - to increase positive end-expiration pressure to restrict outflow of air from the lungs to prevent the small airways from collapsing

Question 9

what causes stridor

Answer 9

Obstruction to the upper airway: High pitched inspiratory noise

Question 10

Bronchiolitis Timeline

Answer 10

• Coryzal Sx
• 1-2D: Chest Sx
• 3-4D: Sx at worst
• Sx last for 7-10D
• 2-3 wks fully recover

Question 11

Bronchiolitis stat hosp admission criteria

Answer 11

• apnoea
• severe respiratory distress (grunting, intercostal or subcostal recession, tracheal tugging)
• RR >60
• central cyanosis
• O2 sat. <92%
• Age under 3 months
• Pre-mature infant (<37 weeks)
• Pre-existing conditions
• intake 50-70% of normal feed
• Clinically dehydrated

Question 12

What Tx are contraindicated with bronchiolitis

Answer 12

• nebulised hypertonic saline
• bronchodilators
• steroids
• Abx

Question 13

At what gestation is RSV vaccine recommeded in pregnant women

Answer 13

28 weeks

Question 14

How long does the RSV antibodies last in a baby

Answer 14

first 6 months of life

Question 15

Bronchiolitis Mx

Answer 15

Respiratory support
- Low-flow oxygen (e.g., 2 litres via nasal cannula)
- High-flow humidified oxygen via a tight nasal cannula (e.g., “Airvo” or “Optiflow”)
- Continuous positive airway pressure (CPAP)
- Intubation and ventilation

To increase PEEP

Question 16

CXR findings for RSV pneumonia

Answer 16

• hyperinflation
• peribronchial thickening
• patchy infiltrates

Question 17

When is an ACG indicated for children with bronchiolotis

Answer 17

when supplemental O2 conc. is >50%

Question 18

MX for poor oral intake children in bronchiolitis

Answer 18

NG fluids/feed

Question 19

Bronchiolitis RED FLAGS

Answer 19

• worsening work of breathing (e.g. grunting, nasal flaring, marked chest recession)
• fluid intake is 50% to 75% of normal
• Dehydration not wetting nappy for 12 hours
• apnoea or cyanosis
• exhaustion (for example, not responding normally to social cues, wakes only with prolonged stimulation).

Question 20

RSV pneumonia presentations

Answer 20

• Severe respiratory distress
• high fever (above 390
• productive cough
• hypoxia
• cyanosis
• Lethargy
• Poor feeding

Question 21

Bronchiolitis managment for children

Answer 21

Conservative: O2 sat. > 92% RR < 70
paracetamol/ibuprofen
fluids
safety net and advise red flags
Hospital admissison: O2 sat < 92%, RR > 70