Key clinical points

NICE recommend immediate referral (usually by 999 ambulance) if they have any of the following:
  • apnoea (observed or reported)
  • child looks seriously unwell to a healthcare professional
  • severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute
  • central cyanosis
  • persistent oxygen saturation of less than 92% when breathing air

Consider referring to hospital if any of the following apply:
  • a respiratory rate of over 60 breaths/minute
  • difficulty with breastfeeding or inadequate oral fluid intake (50-75% of usual volume 'taking account of risk factors and using clinical judgement')
  • clinical dehydration.

Introduction

Bronchiolitis is a condition characterised by acute bronchiolar inflammation. Respiratory syncytial virus (RSV) is the pathogen in 75-80% of cases.

Epidemiology

  • Incidence: 500.00 cases per 100,000 person-years
  • Most commonly see in infants
  • Sex ratio: 1:1
Condition Relative
incidence
Asthma in children1.60
Bronchiolitis1
Croup0.50
<1 1-5 6+ 16+ 30+ 40+ 50+ 60+ 70+ 80+

Clinical features

Features
  • coryzal symptoms (including mild fever) precede:
  • dry cough
  • increasing breathlessness
  • wheezing, fine inspiratory crackles (not always present)
  • feeding difficulties associated with increasing dyspnoea are often the reason for hospital admission

Referral criteria

NICE recommend immediate referral (usually by 999 ambulance) if they have any of the following:
  • apnoea (observed or reported)
  • child looks seriously unwell to a healthcare professional
  • severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute
  • central cyanosis
  • persistent oxygen saturation of less than 92% when breathing air.

NICE recommend that clinicians 'consider' referring to hospital if any of the following apply:
  • a respiratory rate of over 60 breaths/minute
  • difficulty with breastfeeding or inadequate oral fluid intake (50-75% of usual volume 'taking account of risk factors and using clinical judgement')
  • clinical dehydration.

Investigations

Investigation
  • immunofluorescence of nasopharyngeal secretions may show RSV

Management

Management is largely supportive
  • humidified oxygen is given via a head box and is typically recommended if the oxygen saturations are persistently < 92%
  • nasogastric feeding may be needed if children cannot take enough fluid/feed by mouth
  • suction is sometimes used for excessive upper airway secretions