Bronchiolitis

Bronchiolitis

Bronchiolitis is the commonest serious respiratory infection of infancy: 2–3% of all infants are admitted to hospital with the disease each year during annual winter epidemics; 90% are aged 1–9 months (bronchiolitis is rare after 1 year of age). Respiratory syncytial virus (RSV) is the pathogen in 80% of cases. The remainder are accounted for by human metapneumovirus, parainfluenza virus, rhinovirus, adenovirus, influenza virus, and Mycoplasma pneumoniae. Dual infection with RSV and human metapneumovirus is associated with severe bronchiolitis.

[xyz-ihs snippet="Wide-Banner"]

Coryzal symptoms precede a dry cough and increasing breathlessness. Feeding difficulty associated with increasing dyspnoea is often the reason for admission to hospital. Recurrent apnoea is a serious complication, especially in young infants. Infants born prematurely who develop bronchopulmonary dysplasia or with other underlying lung disease, such as cystic fibrosis or have congenital heart disease, are most at risk from severe bronchiolitis. The characteristic findings on examination are:

  • Sharp, dry cough
  • Tachypnoea
  • Subcostal and intercostal recession
  • Hyperinflation of the chest:
    • Prominent sternum
    • Liver displaced downwards
  • Fine end-inspiratory crackles
  • High-pitched wheezes – expiratory > inspiratory
  • Tachycardia
  • Cyanosis or pallor.

Respiratory viruses are now usually identified by PCR analysis of nasopharyngeal secretions. A chest X-ray is unnecessary in straightforward cases, but if performed, typically shows hyperinflation of the lungs due to small airways obstruction, air trapping and often focal atelectasis. Pulse oximetry is used to measure and monitor arterial oxygen saturation continuously. Blood gas analysis, usually a capillary sample, is only performed in severe disease to identify hypercarbia when additional ventilatory support is considered.

This is supportive. Humidified oxygen is delivered via nasal cannulae; the concentration required is determined by pulse oximetry. The infant is monitored for apnoea. Mist, antibiotics, steroids and nebulised bronchodilators, such as salbutamol or ipratropium, have not been shown to reduce the severity or duration of the illness. Fluids may need to be given by nasogastric tube or intravenously. Assisted ventilation in the form of nasal or facemask CPAP or full ventilation is required in a small percentage of infants admitted to hospital. RSV is highly infectious, and infection control measures, particularly good hand hygiene, are needed to prevent cross-infection to other infants in hospital.

Most infants recover from the acute infection within 2 weeks. However, as many as half will have recurrent episodes of cough and wheeze (see below). Rarely, usually following adenovirus infection, the illness may  result in permanent damage to the airways (bronchiolitis obliterans).

A monoclonal antibody to RSV (palivizumab, given monthly by intramuscular injection) reduces the number of hospital admissions in high-risk preterm infants. Its use is limited by cost and the need for multiple intramuscular injections.

Reference – Illustrated Textbook of Paediatrics 4th Edition

Share this :
  • 287
    Shares

Bone Diseases

Bone Diseases Share this : Intercostal Tube Intercostal Tube A Intercostal tube (chest tube) is a hollow, flexible tube placed…

Types of Paralysis

Types of Paralysis Share this : Otosclerosis Otosclerosis Otosclerosis, usually an hereditary disorder, causes abnormal bone to be formed around…

Dysphagia Differential Diagnosis

Dysphagia Carcinoma of the oesophagus Progressive dysphagia initially or solids then for liquids Associated regurgitation of undigested food Loss of…

Accommodation reflex

Accommodation reflex The process by which the curvature of the lens is increased is called accommodation. At rest, the lens…

Appendicitis

Appendicitis This is the commonest cause of the acute abdomen. It usually occurs when there is an obstruction in the…

Cellulitis

Cellulitis Share this : Anti Anginal Drugs Anti Anginal Drugs Share this : Hearing Tests Hearing Tests Voice tests and…

Our mission is to provide a free, reliable and first-class education to everyone.

Rish Academy is a nonprofit organization. 

Every little bit counts and is appreciated.

Find us on