Bronchiolitis

Bronchiolitis

Symptoms

Coryza for one to two days followed by persistent cough, breathlessness, hyperinflation, and expiratory wheeze in a 1 to 12 month old. Fine crackles and cyanosis correlate with severe disease. Respiratory syncitial virus (RSV) is the usual cause ( occasionally parainfluenza).

Epidemiology

1. 1-2 % of all infants are admitted to hospital with bronchiolitis.
2. Occurs in winter to early spring.
3. Breast feeding and parental avoidance of smoking is protective.

Pathology

1. Inflammation of the bronchioles: secretion of mucus, necrosis of ciliated epithelium and oedema of the submucosa leading to airways obstruction. 2. Hyperinflation and patchy segmental collapse of the lung.

Clinically

1. Tachypnoea, cyanosis and inability to feed.
2. Head bobbing and unresponsiveness.
3. 1% progress to respiratory failure.
4. Apnoea, especially in the premature.
5. Cardiac failure is unusual.

Investigations

1. RSV detected by immunofluorescence of nasopharyngeal secretions.
2. CXR shows square chest, horizontal ribs, hilar streaking, with subsegmental collapse or
consolidation in 35%.
3. Blood gases show hypoxia

Differential

1. Asthma
2. Bronchopneumonia 3. Cystic fibrosis
4. Heart failure

Management:

1. Admit to hospital if respiratory or feeding difficulties. 2. Feed via iv or NG if indicated.
3. Oxygen for pallor or cyanosis. Pulse oximetry.
4. Bronchodilators
5. Mechanical ventilation.