Bronchiolitis in children

Bronchiolitis in Children
Prof. Dr. Saad S Al Ani
Senior Pediatric Consultant
Head of Pediatric Department
Khorfakkan Hospital
Sharjah, UAE
Saad.alani@moh.gov.ae

Bronchiolitis is caused by a viral infection and is
seasonal ,peaking in the winter months.
The most common cause is respiratory syncytial
virus (RSV) which accounts for 80% of cases
Other respiratory viruses that cause bronchiolitis:
• Rhinovirus
• Adenovirus
• Influenza virus
• Parainfluenza
Bush A. Thomson AH..acute Bronchiolitis.BMJ2007,335(7628):1037-1041
25/09/2017
Bronchiolitis in children
2

Bronchiolitis is the most common disease of the
lower respiratory tract during the first year of life
Children present with :
• Cough
• Increased work of breathing
• Difficulty with feeding
About 1 in 3 infants will develop bronchiolitis in the
first year of life
About 2% -3% of all infants will need admission to
hospital
Deshpande SA, Northern V.The clinical and health economic burden of respiratory syncytial virus disease among
children under 2 years of age in a defined geographical area. Arch Dis Child2003,88(12):1065-9.
25/09/2017
3

Young infants( especially those under 6 weeks)
may present with apnea without other clinical signs)
Apnea is considered a ‘ red flag’ symptoms that
need emergency care in the hospital
National Institute for Health and Care Excellence. Bronchiolitis in children: diagnosis and management.
NICE guidelines {NG9}.2015.
https://www.nice.org.uk/guidance/ng9
25/09/2017
4

• Apnea (Observed or reported)
• The child look seriously unwell
• Severe respiratory distress:
 Grunting
 Marked chest recessions
 Respiratory rate above 70 breaths per minute
• Central cyanosis
• Oxygen saturations persistently below 92% when
breathing air
Emergency consideration
Scottish Intercollegiate Guidelines Network. Bronchiolitis in children: A national clinical guideline .2006.
http://www.sign.ae.uk/pdf/sign91.pdf
25/09/2017
5

• Most children:
 Will have mild disease that is self limiting
 Can be managed at home
• Some children
 Have more severe respiratory distress
 Needing treatment
• Few children :
 Will deteriorate rapidly
 Develop severe life threatening
bronchiolitis
 Need urgent treatment
25/09/2017
6

Clinical features that may be important predictors of
deterioration include:
• Length of illness ( a deterioration is more likely in the
early stages of the disease)
• Heart rate above 97th centile
• Respiratory rate above 70 breaths per minute
• Fever
• Oxygen saturation below 92%
• Ability to feed
Walsh P,et al.A validated clinical model to predict the need for admission and length of stay in children with
acute bronchiolitis. Eur J Emerg Med2004;11(5):265-72
Corneli HM,et al. Bronchiolitis: clinical characteristics associated with hospitalization and length of stay.
Pediatr Emerg care 2012;28(2):99-103
25/09/2017
7

Referral indications to hospital
If any of the followings is present in a child with
bronchiolitis, referral to hospital is indicated:
• Respiratory rate > 60 breath per minute
• Difficulty with breastfeeding or inadequate oral
intake
• Clinically dehydrated
• Chronic lung disease
• Congenital Heart disease
• Age under 3 months
• Premature birth(<32 weeks gestation)
• A neuromuscular disorder
• Immunodeficiency
25/09/2017
8

Think of Bronchiolitis as a diagnosis if the
child has a coryzal prodrome that lasts
between 1-3 days and is followed by:
• A persistent cough AND
• Tachypnea or chest recession for both ,
AND
• Wheeze or crackles on auscultation for
both
https://www.linkedin.com/pulse/who-do-you-think-pete-baker
Diagnosis
25/09/2017
9

Colourbox
Do not perform a routine chest x ray
Generally the diagnosis of bronchiolitis is Clinical
and investigations are not considered helpful
Chest x ray can’t discriminate between
bronchiolitis and other lower respiratory tract
infections
Stephens D, Lalani A, Schuh S. Predictors of major intervention in
infant with bronchiolitis. Pediatr Pulmonol2009;44(4):358-63
25/09/2017
10

• The treatment for bronchiolitis is Supportive
• No effective drug treatment
Bronchiolitis is a viral and the rate of secondary
bacterial infection is very rare
Significant disadvantages associated with use of
antibiotics:
• Adverse reactions
• Bacterial resistance
• Cost implications
Luo Z, Fu Z, Liu E ,et al. Nebulized hypertonic saline treatment in hospitalized children with
moderate to severe viral bronchiolitis. Clin Microbiol Infect2011;17(12):1829-33
25/09/2017
11

Ineffective treatments
All of the followings should not be used to treat
children with bronchiolitis:
• Antibiotics
• Hypertonic saline
• Nebulized adrenaline
• Salbutamol
• Montelukast
• Ipratropium bromide
• Systemic or inhaled corticosteroids
25/09/2017
12

When to give oxygen
wiseGEEK
Oxygen supplementation is needed if a child’s
oxygen saturated is persistently < 92% in air
No routine oxygen for all children with
bronchiolitis
25/09/2017
13

The following informations to parents caring for
children with bronchiolitis at home:
• ‘Red flag’ symptoms:
 Worsening of breathing work:
 A reduced fluid intake
 Apnea or cyanosis
 Exhaustion
• Avoid smoking at home
• Follow up
25/09/2017
14

Bronchiolitis versus Asthma
25/09/2017
15

Clinical Features of Bronchiolitis
• Starts with upper respiratory tract symptoms:
 Nasal obstruction
 Cough
• Progresses over 3-4 days to involve the
bronchioles:
 Dyspnea
 Poor feeding
• On auscultation: mixture of wheeze and crackles
25/09/2017
16

Asthma
• It is less commonly under 1 year of age
• Recurrent respiratory symptoms:
 Wheeze
 Cough
 Difficulty of breathing
 Chest tightness
• Symptoms worse after exposure to triggers and at night
• Personal or family history of atopy or asthma
• On auscultation: widespread wheeze
• Improve lung function after adequate treatment
Wu P, Hartert TV. Evidence for a causal relationship between respiratory syncytial virus infection and asthma. Expert
Rev Anti Infect Ther2011;9(9):731-45
25/09/2017
17

Post bronchiolitis syndrome
• Recovery takes between 5 – 7 days
• Persistent cough lasts >2 weeks occur in 50%
• Infants have increase frequency of subsequent wheeze
• Some children get chronic and relapsing episodic
wheezing with subsequent viral infections
• Association between RSV and later on development of
asthma is well documented
Wu P, Hartert TV. Evidence for a causal relationship between respiratory syncytial virus infection and asthma. Expert
Rev Anti Infect Ther2011;9(9):731-45.
25/09/2017
18

References
• Bush A. Thomson AH..acute Bronchiolitis.BMJ2007,335(7628):1037-1041
• Deshpande SA, Northern V.The clinical and health economic burden of respiratory syncytial virus disease among children
under 2 years of age in a defined geographical area. Arch Dis Child2003,88(12):1065-9
• National Institute for Health and Care Excellence. Bronchiolitis in children: diagnosis and management. NICE guidelines
{NG9}.2015. https://www.nice.org.uk/guidance/ng9
• Scottish Intercollegiate Guidelines Network. Bronchiolitis in children: A national clinical guideline .2006.
http://www.sign.ae.uk/pdf/sign91.pdf
• Walsh P,et al.A validated clinical model to predict the need for admission and length of stay in children with acute
bronchiolitis. Eur J Emerg Med2004;11(5):265-72
• Corneli HM,et al. Bronchiolitis: clinical characteristics associated with hospitalization and length of stay. Pediatr Emerg care
2012;28(2):99-103
• Stephens D, Lalani A, Schuh S. Predictors of major intervention in infant with bronchiolitis. Pediatr Pulmonol2009;44(4):358-
63
• Luo Z, Fu Z, Liu E ,et al. Nebulized hypertonic saline treatment in hospitalized children with moderate to severe viral
bronchiolitis. Clin Microbiol Infect2011;17(12):1829-33
• Wu P, Hartert TV. Evidence for a causal relationship between respiratory syncytial virus infection and asthma. Expert Rev
Anti Infect Ther2011;9(9):731-45
25/09/2017
19

Dreamstime.com
25/09/2017
20

Bronchiolitis in children

Recommandé

Recommandé

Contenu connexe

Tendances

Tendances (20)

En vedette

En vedette (20)

Similaire à Bronchiolitis in children

Similaire à Bronchiolitis in children (20)

Plus de Dr. Saad Saleh Al Ani

Plus de Dr. Saad Saleh Al Ani (20)

Dernier

Dernier (20)

Bronchiolitis in children