Acute Bronchiolitis

Paediatrics

Viral lower-respiratory infection (usually RSV) in infants <2 y causing wheeze and respiratory distress.

Clinical features

  • • Coryza progressing to cough, wheeze
  • • Tachypnoea, recessions
  • • Poor feeding
  • • Apnoea (young infants)

Examination

  • • Fine crackles + wheeze
  • • Hyperinflation
  • • Hypoxia

Investigations

  • • Clinical diagnosis
  • • NPA for RSV if admitted
  • • CXR only if atypical
  • • Capillary blood gas if severe

Differential diagnosis

  • • Pneumonia
  • • Heart failure
  • • Foreign body aspiration
  • • Pertussis

Management

  • • Supportive: O₂ to keep SpO₂ ≥92%, NG/IV fluids
  • • HFNC / CPAP for moderate–severe
  • • Bronchodilators NOT routinely indicated

Drug therapy

  • • Palivizumab prophylaxis in high-risk preterm
  • • Avoid steroids/antibiotics unless co-infection

Complications

  • • Respiratory failure
  • • Apnoea
  • • Secondary bacterial infection

Clinical pearls

  • • Most <12 m infants manage at home; admit if SpO₂ <92%, poor feeding, apnoea

Educational — verify locally.

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