Bronchiolitis
Not yet clinically reviewed
This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.
Introduction
Bronchiolitis is an acute viral infection of the lower respiratory tract of infants that affects ~50% of children during the first year of life and 100% by 3 years.
- Respiratory syncytial virus is the most common cause of bronchiolitis, accounting for up to 75% of all cases. Parainfluenza viruses are the second most common cause. Bacteria serve as secondary pathogens in only a small minority of cases.
Clinical Presentation of Bronchiolitis
Signs and symptoms : Prodrome with irritability, restlessness, and mild fever Cough and coryza Vomiting, diarrhea, noisy breathing, and an increase in respiratory rate as symptoms progress Labored breathing with retractions of the chest wall, nasal flaring, and grunting
Physical examination : Tachycardia and respiratory rate of 40–80/min in hospitalized infants Wheezing and inspiratory rales Mild conjunctivitis in one-third of patients Otitis media in 5% to 10% of patients
Laboratory examinations : Peripheral white blood cell count normal or slightly elevated Abnormal arterial blood gases (hypoxemia and, rarely, hypercarbia).
Treatment
- Bronchiolitis is a self-limiting illness and usually requires no therapy (other than reassurance, antipyretics, and adequate fluid intake) unless the infant is hypoxic or dehydrated.
- Ribavirin may be considered for bronchiolitis caused by respiratory syncytial virus in a subset of patients.