Bronchiolitis
Description Diagnostic criteria General and supportive measures Medicine treatment Referral ICD-10 code: J21.9 DESCRIPTION Bronchiolitis is an acute viral infection of the small airways of the lower respiratory tract affecting children between 4 months and 2 years of age. The most common pathogen is the respiratory syncytial virus. Recurrent episodes of wheeze associated with bronchiolitis
Description
Diagnostic criteria
General and supportive measures
Medicine treatment
Referral
ICD-10 code: J21.9
DESCRIPTION
Bronchiolitis is an acute viral infection of the small airways of the lower respiratory tract affecting children between 4 months and 2 years of age. The most common pathogen is the respiratory syncytial virus. Recurrent episodes of wheeze associated with bronchiolitis may occur, and some of these children may develop asthma.
Risk factors for severe bronchiolitis:
- Age less than 3 months.
- Ex-preterm infants.
- Chronic lung disease.
- Congenital heart disease.
DIAGNOSTIC CRITERIA
- Prodrome of viral infection: irritability and rhinorrhoea.
- A wheeze that is slowly responsive or non-responsive to bronchodilators.
- Crepitations and signs of hyperinflation of the chest.
- Chest X-ray should be reserved for clinically severe or complicated cases.
- Tachypnoea is age dependent.
| Age | Respiratory rate |
| < 60 days | > 60/minute |
| 2–12 months | > 50/minute |
| 1–5 years | > 40/minute |
| 5–12 years | > 25/minute |
Bronchiolitis (mild)
- Cough and fast breathing (tachypnoea).
Bronchiolitis (moderate)
Above plus one of the following:
- lower chest wall in-drawing,
- nasal flaring,
- grunting.
Bronchiolitis (severe)
Above plus at least one of the following:
- central cyanosis, oxygen saturation < 90% in room air;
- inability to feed,
- convulsions, lethargy or decreased level of consciousness,
- severe respiratory distress (e.g. very severe chest wall indrawing).
GENERAL AND SUPPORTIVE MEASURES
- Isolate from other infants, if possible.
- Mild cases without risk factors are managed as outpatients. Provide counselling to the caregiver and devise a plan for the eventuality that the child deteriorates or does not improve. Mild cases with risk factors, moderate and severe cases require admission.
- Patients with signs of moderate or severe disease or associated complications or underlying cardiorespiratory disorders should be hospitalised for monitoring of:
- breathing pattern (apnoea monitoring if < 3 months of age),
- heart rate and respiratory rate,
- temperature,
- SaO2,
- hydration and nutrition,
- IV maintenance fluid if oral/nasogastric feeds/fluids are not tolerated. Avoid over hydration.
MEDICINE TREATMENT
For all hospitalised patients
Only if saturation < 92%:
- Oxygen, humidified, 1–2 L/min via nasal prongs or nasal cannula.
- Ensure clear nasal passages and correctly position the nasal prongs.
In children with recurrent wheezing, nebulise with a β2-agonist, if there is a response consider asthma, See: 15.4 Conditions with predominant wheeze.
Antibiotic therapy
Routine antibiotic therapy is not indicated. Only use antibiotics if there is concern about bacterial co-infection.
For bacterial co-infection:
- Amoxicillin, oral, 45 mg/kg/dose, 12 hourly for 5 days.
REFERRAL
- Discuss all severe cases with a paediatrician.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Hospital Level, Paediatrics, 2023 Edition
Chapter 15: Respiratory System, 15.1 Cough With Predominant Fever And Tachypnoea, 15.1.2 Bronchiolitis