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Bronchiolitis

  

Bronchiolitis is a generally self limiting viral illness characterised by a prodrome of coryza, prior to cough and often wheeze.


Occurs in babies and infants upto the age of 18 months. Clinical examination reveals crackles +/- wheeze on auscultation in addition to coryza and a wet cough. Under 6 weeks of age babies may present with apnoea as the only symptom.

Symptoms peak day 3-5 but cough may last up to 3 weeks and does not require treatment. Many children have fever but generally < 39 degrees. For the majority of babies and infants bronchiolitis is a self limiting illness that can be managed at home.

Treatment

There remains no evidence based treatment for bronchiolitis other than supportive care. There is no evidence for the use of salbutamol, ipratropium, steroids (inhaled or oral) or antibiotics in bronchiolitis. Supportive treatment (oxygen and fluid support) requires hospital admission. Parents should be warned about the expected duration of symptoms and in particular the cough. Hi-flow oxygen or CPAP is often used and may uncommonly need ventilation and transfer to a PICU.

Babies requiring consideration of review by secondary care

  • If RR > 60, +/- more than mild respiratory distress.
  • Inadequate feeding (< half normal) or not wetting nappies in 12 hour period, or clinically dehydrated
  • Sat < 92% in air (need oxygen – transport via ambulance),

Risk factors

  • < 3 months age
  • Chronic lung diease
    Congenital heart disease
  • Prematurity particularly < 32/40
  • Neuromuscular conditions.

Babies with risk factors should have a lower threshold for assessment in secondary care as they are more likely to deteriorate faster and need supportive care. Babies presenting early in the illness (day1/day 2) who do not require intervention should be warned about the possibility of deterioration and when to seek medical review.

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