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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