• acute viral infection

  • bronchioles of lower respiratory tract

  • most RSV

• risk factors

  • birth feb and july

  • prematurity

  • maori/pacific

    • hospitlaised 3-5x higher

  • maternal smoking during pregnancy

  • socioeconomic status of infants community

  • low birth weight

diagnosis

• clinical

• cxr should not be routinely performed

• likely if:

  • \<18mo

  • initial signs and symptom of URTI

  • cough

  • tachypnoea

  • insp. creps

  • wheeze

• dehydration may occur due to difficulties with feeding and losses with tachypnoea

• low grade fever

• if high fever: alternate diagnosis considered

  • penumonia

• wheeze \<1yr

  • bronchiolitis not asthma

  • may have degree of response to beta-2-agonist

    • consider trial; >9mo with recurrent wheeze

Treatment

assess severity;

encourage small frequnet feeds

nassal congestion; try saline nassal drops

reassure that improvement expected wihtin 3d

return if any concern or symptoms become severe

mild:

• signs

  • normal RR

  • no or subtle accessory muslce use

  • normal HR

  • able to feed

  • O2 Spo2 >95%

• treatment

  • reassurance

  • home care

Moderate

• signs

  • increase resp rate

  • minor accessory msucle use

  • increase HR

  • difficulty feeding

  • minor dehydration

  • crepitations

  • o2 sat 90-95%

• treamtnet

  • consider refer if:

    • \<3mo

    • not feeding sufficiently

    • parental distress

    • social circumstances = concern

severe

• signs

  • poor resp effort, cyanosis, ,apnoea may indicate life threatening bronchiolitis

  • RR >60

  • moderate/marked accessory muscle use

  • nasal flare and/or grunting

  • markedly increase HR

  • feeding \<50% of normal in preceding 24horus

  • marked dehydration

    • sunken fontanelle

    • sunken eyes

    • reduced skin turgor

    • low urine production

    • absent tears

  • toxic appearance

  • O2 \<90%

• tratmnet

  • send to hospital by ambulance

  • O2 if available

reduce reinfection:

explain bronchiolitis

housing conditions

keep rooms at constant comfortable temperature

encourage and support smokefree environment

encourage parents to return or seek assistance if there are concerns re baby’s breathing, ability to feed or general well being

bronchiolitis easily spread

handwashing

avoid cold/flu