Bronchiolitis

Bronchiolitis

epidemiology
1. commonest serious respiratory infection of infancy
2. 2-3% of all infants admitted to hospital/ yr during annual winter epidemics
3. 90% of cases are 1-9 mths old
4. rare after 1 year of age
pathogen
1. virus
  1. RSV
    1. causes 80% of cases
    2. highly infectious
  2. human metapneumovirus
  3. parainfluenza virus
  4. rhinovirus
  5. adenovirus
  6. influenza
2. bacteria
  1. Mycoplasma pneumoniae
clinical features
1. coryzal sx
  1. followed by
    1. dry cough
    2. increasing breathlessness
2. feeding difficulty
  1. assoc w/ increasing dyspnoea
    1. often reason for hosp admission
3. on examination
  1. sharp dry cough
  2. tachypnoea
  3. hyperinflation of chest
    1. prominent sternum
    2. liver displaced downwards
  4. fine end-inspiratory crackles
  5. +/- high pitched wheezes- exp> insp
  6. tachycardia
  7. cyanosis or pallor
  8. subcostal & intercostal recession
complications
1. serious
  1. recurrent apnoea
    1. esp in young infants
      1. < 4 mths old
high risk groups for severe bronchiolitis
1. premature infants
  1. who developed bronchopulmonary dysplasia
  2. w/ underlying lung disease
    1. Cystic fibrosis
  3. w/ congenital heart disease
Ix
1. nasopharyngeal secretions (aspirate?)
  1. PCR
    1. ID resp viruses
2. CXR
  1. unnecessary in straightforward cases
    1. rarely helpful in bronchiolitis
  2. signs
    1. hyperinflation of lungs
      1. due to small airways obstruction
    2. flattening of diaphragm
    3. air trapping
    4. focal atelectasis
    5. horizontal ribs
    6. increased hilar bronchial markings
3. pulse oximetry
  1. continuous monitoring of arterial O2 sats
4. blood gas analysis
  1. from capillary sample
    1. done only in severe disease
      1. to ID hypercarbia when additional ventilatory support is needed
Mx
1. supportive
  1. humidified O2
    1. via nasal cannulae
    2. conc needed determined by pulse oximetry
  2. monitoring
    1. for apnoea
  3. fluids
    1. NG
    2. IV
  4. ventilation
    1. assisted
      1. nasal CPAP
      2. facemask CPAP
    2. full
2. infection control
Prognosis
1. most recover from acute infection within 2 weeks
2. 1/2 will have recurrent episodes of cough and wheeze
3. rare
  1. ff adenovirus infection
    1. bronchiolitis obliterans
      1. permanent damage to airways
prevention
1. palivizumab
  1. monoclonal antibody to RSV
  2. monthly i.m. injection
  3. reduces risk of hosp admissions in high-risk preterm infants
  4. costly
  5. multiple i.m injections needed

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	Created by v.djabatey over 10 years ago