Bronchiolitis (peds)

Background

• <2yr old (peak 2-6mo age)
  • Preemies, neonates, congenital heart dz are at risk for serious disease
• Peak in winter

Diagnosis

• Symptoms
  • Rhinorrhea, cough, irritability, periods of apnea (neonates)
• Signs
  • Tachypnea, cyanosis, wheezing, retractions
  • Fever is usually low-grade or absent
    • If high-grade fever consider OM, UTI

Work-Up

• Rapid RSV
  • Obtain if <1mo old
  • If positive then admit pt

• CXR
  • Not routinely necessary
    • May lead to unnecessary use of abx (atelectais mimics infiltrate)
  • Consider if
    • Diagnosis unclear
    • Critically ill

DDx

1. Asthma
2. PNA
3. FB
4. Pertusis
5. CHF
6. Cystic fibrosis
7. Vascular ring
8. CA

Treatment

1. O2 (maintain SaO2 >90%)
2. Racemic epi neb
   1. Only repeat if initial beneficial response
3. Suction nares
4. No steroids

Disposition

Consider admission for:

1. Underlying heart/lung disease
2. Preterm (<34wks)
3. Age <3months
4. Initial SaO2 <92%
5. Unable to tolerate PO

Source

Rosen's, Tintinalli