Bronchiolitis

It may be difficult to tell the difference between bronchiolitis and pneumonia. Bronchiolitis is an acute viral infection of the small airways of lower respiratory tract affecting children between 4 months to 2 years of age. The most common pathogen is the respiratory syncytial virus. Children with bronchiolitis typically present with wheeze, hyperinflation, can have crackles and coryza, but without bronchial breathing, sputum production or high fever.

Diagnostic criteria

• Prodrome of viral infection: irritability and feeding difficulties.
• A wheeze that is slowly responsive or non-responsive to bronchodilators.
• Crepitations and signs of hyperinflation of the chest.
• A chest X-ray is useful in confirming hyperinflation and associated segmental atelectasis.

Hospital Admission Required If:

• Not drinking well
• Have cyanosis or require supplemental oxygen to keep Sats above 90%.
• Are grunting or tachypnoeic
• Have significant subcostal / intercostals recession at rest
• Have poor socio-economic circumstances making rapid return difficult
• An infant with a history of apnoeic episodes.

Management

1. Oxygen, humidified, 1–2 L/min via nasal prongs or nasal cannula if saturation < 92%.
2. Nebulise with Sodium chloride 3% solution, 2–4 mL, 4 hourly. Mix 3 mL of 5% sodium chloride with 2 mL water to make 3% solution. If there is poor response or deterioration, add Adrenaline 1: 1 000, 1 mL diluted in 2–4 mL sodium chloride 3% every 2–4 hours
3. Routine antibiotic therapy is not indicated. Only use antibiotics if there is: raised leukocyte count, persistent high fever of > 38.5oC, or a CXR showing opacification suggestive of pneumonia. For suspected secondary bacterial infection: Amoxicillin oral, 30 mg/kg/dose, 8 hourly for 5 days.
4. There is no evidence that B2-agonists, anticholinergics, inhaled corticosteroids or leukotriene receptor antagonists have any benefit in these children. In severe disease requiring intensive care, oral corticosteroids may be considered after specialist consultation.