Bronchiolitis (peds)

Background

• <2yr old (peak 2-6mo age)
• Preemies, neonates, congenital heart dz are at risk for serious disease
• Peaks in winter
• Duration = 7-14d (worst during days 3-5)
• Inflammation, edema, and epithelial necrosis of bronchioles

Diagnosis

• Symptoms
  • Rhinorrhea, cough, irritability, apnea (neonates)
• Signs
  • Tachypnea, cyanosis, wheezing, retractions
  • Fever is usually low-grade or absent
    • If high-grade fever consider OM, UTI
• Assess for dehydration (tachypnea may interfere with feeding)

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

• Infants <60 days with RSV bronchiolitis and fever
  • Concern is for SBI with RSV
  • UTI 5.4% in RSV+, 10.1% RSV-
  • Bacteremia 1.1% RSV+, 2.3% RSV-
  • Meningitis 0% RSV+, 0.9% RSV-
  • CONCLUSION-Low risk of bacteremia and meningitis in RSV+, still appreciable UTI risk

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. +/- albuterol
4. Suction nares / nasal saline drops
5. Steroids are controversial (?efficacy)

Disposition

Consider admission for:

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

See Also

Croup

Source

• Rosen's, Tintinalli
• Pediatrics.2004 Jun;113(6):1728-34