When does bronchiolitis occur?

When diagnosing bronchiolitis, take into account that it occurs in children under 2 years of age and most commonly in the first year of life, peaking between 3 and 6 months.

When diagnosing bronchiolitis, take into account that symptoms usually peak between 3 and 5 days, and that cough resolves in 90% of infants within 3 weeks.

How to diagnose bronchiolitis  ?

Diagnose bronchiolitis if the child has a coryzal prodrome lasting 1 to 3 days, followed by:

persistent cough and either tachypnoea or chest recession (or both) and either wheeze or crackles on chest auscultation (or both).

When diagnosing bronchiolitis, take into account that the following symptoms are common in children with this disease:

fever (in around 30% of cases, usually of less than 39°C)

poor feeding (typically after 3 to 5 days of illness).

When diagnosing bronchiolitis, take into account that young infants with this disease (in particular those under 6 weeks of age) may present with apnoea without other clinical signs.

When to admit a child with bronchiolitis?

Consider referring children with bronchiolitis to hospital if they have any of the following:

a respiratory rate of over 60 breaths/minute

difficulty with breastfeeding or inadequate oral fluid intake (50–75% of usual volume, taking account of risk factors (see when to admit [See page 5]

clinical dehydration.

Which are the high risk factors for bronchiolitis? 

chronic lung disease (including bronchopulmonary dysplasia)

haemodynamically significant congenital heart disease age in young infants (under 3 months)

premature birth, particularly under 32 weeks

neuromuscular disorders

immunodeficiency.

How to assess a child in the hospital?

When assessing a child in a secondary care setting, admit them to hospital if they have any of the following:

apnoea (observed or reported) persistent oxygen saturation of less than 92%

when breathing air inadequate oral fluid intake (50–75% of usual volume, taking account of )

persisting severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute.

How to suspect impending respiratory failure?

if impending respiratory failure and continuous positive airway pressure ), if any of the following are present:

signs of exhaustion, for example listlessness or decreased respiratory effort

recurrent apnoea

failure to maintain adequate oxygen saturation despite oxygen supplementation.

When to consider pneumonia?

Consider a diagnosis of pneumonia if the child has: high fever (over 39°C) and/or persistently focal crackles.

When to consider viralninduced wheeze or asthma?

Think about a diagnosis of viral-induced wheeze or early-onset asthma rather than bronchiolitis

in older infants and young children

if they have: persistent wheeze without crackles or

recurrent episodic wheeze or a personal or

family history of atopy.

What is the

Management

Humidifierd o2 in sat <92%

Hfnc for o2 administration

Treatments that should not be used

• antibiotics
• hypertonic saline
• adrenaline (nebulised)
• salbutamol
• montelukast
• ipratropium bromide
• systemic or inhaled corticosteroids
• a combination of systemic corticosteroids and nebulised adrenaline.