Difference between revisions of "Bronchiolitis (peds)"

(Diagnosis)
Line 12: Line 12:
 
**Tachypnea, cyanosis, wheezing, retractions
 
**Tachypnea, cyanosis, wheezing, retractions
 
**[[Fever]] is usually low-grade or absent
 
**[[Fever]] is usually low-grade or absent
***If high-grade fever consider [[OM]], [[UTI]]
+
***If high-grade fever consider [[Otitis Media]], [[UTI]]
 
*Assess for dehydration (tachypnea may interfere with feeding)
 
*Assess for dehydration (tachypnea may interfere with feeding)
  

Revision as of 03:27, 22 March 2014

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
  • 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. Foreign Body
  4. Pertusis
  5. CHF
  6. Cystic fibrosis
  7. Vascular ring
  8. CA

Treatment[1][2]

  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
    1. Consider 0.6mg/kg of dexamethasone
Randomized controlled trials of bronchodilater or corticosteroid therapy have shown mixed results. Bronchodilators could aggravate the symptoms.[3][4][5]

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
  1. Cherry J. Clinical practice. Croup. NEJM. 2008; 358; 68:453-456
  2. Zorc J. Bronchiolitis: recent evidence on diagnosis and management. Pediatrics. 2010: 125:343-349
  3. Bjornson CL. et al. A randomized trial of a single dose of oral dexamethasone for mild croup. NEJM. 2004;351:1306-1313.
  4. Geelhoed GC. et al. Efficacy of a small single dose of oral dexamethasone for outpatient croup: a double blind placebo controlled clinical trial. BMJ. 1996;313:140-142
  5. Ralston S. et al. Randomized, placebo-controlled trial of albuterol and epinephrine at equipotent beta-2 agonist doses in acute bronchiolitis. Pediatr Pulmonol. 2005;40:292-299