Viral bronchiolitis
primarily referring to infective causes, i.e. the grunting babies
but this can be caused by other causes in adults too
| welcome to winter! | |
|---|---|
| Etiology | 80% caused by Respiratory syncytial virus, but other viruses can cause eg parainfluenza |
| Epidemiology | resp droplet spread. Age <3 |
| Clinical presentation | Respiratory distress, diffuse wheeze and crackles Peak night 2-3 Apnoeas more common in neonates Ddx: Viral induced wheeze, congenital heart disease |
| Pathogenesis | small airway obstruction ± ROS |
| Investigations: | Clinical diagnosis NP aspirate CXR mostly doesn't change management. May see hyperinflation, increased peribronchial markings |
| Management: | oxygen, fluids, nasal CPAP ➥ Respiratory support: wafting/nasal cannulae → HFNO (usually start with 2L/kg) ➥ DOUBLE CHECK!! Hypertonic saline/adrenaline nebs ........ evidence??? ➥ Salbutamol will not help! ➥ Complete recovery in 4-8/52 ➥ High risk infants = <29/40, chronic lung disease, oxygen requirement etc. → palivizumab prophylaxis |
Red flags - always refer to local guidelines
- Not feeding (at least 1/2 normal feed)
- Apnoeas, cyanotic episodes
- Ex-prem, co-existing heart problem
- Work of breathing