"Qn 123" - tibebe

[ArchivalUser]

Thanks.

[ArchivalUser]

bronchiolitis mgt

* Patients at high risk and patients with moderate respiratory distress or persistent hypoxemia should be admitted for the following:
o Supplemental oxygen

o Apnea monitoring if indicated by age or history (RSV is associated with central apnea for unknown reasons. Term infants younger than age 1 month and premature infants younger than 48 weeks postconception are at highest risk.)
o Restoration and/or maintenance of fluid balance
* Children with severe respiratory distress or impending respiratory failure should be admitted to a pediatric ICU.
* Otherwise healthy children with bronchiolitis have a low risk for bacterial superinfection or coexisting bacterial infection. The febrile infant with findings consistent with bronchiolitis but no other apparent source of infection may require some evaluation for alterative bacterial sources especially if very young (60/min or retractions at rest)
o Apnea or risk of apnea
o Age younger than 2 months or history of prematurity
o Underlying cardiopulmonary disease or immunosuppression

Further Outpatient Care

* Patients with mild disease with reliable caregivers may be discharged. Follow-up evaluation with a primary care provider within 24 hours is desirable.
* Criteria for discharge
o No respiratory distress (eg, respiratory rate 93%
o Age older than 2 months without a history of prematurity
o Reliable caregivers with transportation available
o No underlying cardiopulmonary disease
o Able to take liquids by mouth without difficulty

Inpatient & Outpatient Medications

* Beta-agonists, administered by inhaler or nebulizer, may be continued as an outpatient if the child responds to them while in the ED.
* If inhalers are prescribed, a mask and spacer should be provided and the patient's caregiver instructed in their use prior to discharge.

Transfer

* Severely ill children should be admitted to a pediatric or neonatal intensive care unit. If this requires transfer to another hospital, transport personnel and vehicles specifically intended for pediatric transport are desirable.

Prognosis

* Most children with bronchiolitis, regardless of severity, recover without sequelae. The course of disease is usually 7-10 days, but a few remain ill for weeks.
* Bronchiolitis has been identified as a risk factor for asthma, but this does not necessarily imply causation. Children already predisposed to asthma may be more likely to wheeze when they have RSV or other respiratory infectious or allergic stimuli. On the other hand, it is postulated that RSV infection may predispose an individual to later bronchospasm by selective promotion of specific subsets of helper T cells.