Quick Ref Guide

Full: what0-18 guide

Expected Feed Volumes- HERE

Actions

• Green – Send Home: Provide appropriate and clear guidance to the parent / carer and refer them to the patient advice sheet.
• Amber – Advice from Paediatrician should be sought and/or a clear management plan agreed with parents.
• Red – Move to Resus IMMEDIATE Senior/Paediatiric assessment

Background

• Bronchiolitis is seasonal (winter) viral lower respiratory tract infection
• Affects children under 2 years – 1 in 3 infants will develop bronchiolitis
• 2-3 % all infants with bronchiolitis will require admission to hospital
• Causes: RSV, rhinovirus, adenovirus, influenza, parainfluenza

Clinical Presentation

• Nasal Discharge; Wheezy cough; Fever; On auscultation – fine crackles / expiratory wheeze
• Self-limiting illness
• Duration depends on severity, causative agent and associated high risk conditions
• Day 1-2 – viral URTI with coryza
• Day 2-3 – signs and symptoms of LRTI
• Day 3-4 – peak of illness
• Day 5-7 – gradual improvement
• Cough continues for some weeks

High risk conditions

• Prematurity
• Chronic lung disease of prematurity
• Pre-existing airway problems
• Congenital cardiac disease
• Age <2 months
• Immunodeficiency
• Neuromuscular disease

What to do

• Assess severity: (see flow sheet)
• Hypoxia (<92%): give oxygen immediately
• MILD – no specific treatment – reassurance, advise small frequent feeds and seek medical advice if poor feeding / increased work of breathing / lethargy. GIVE ADVICE SHEET
• MODERATE –Refer to Paeds – admit to PAU / ward for observation. If feeding and no further deterioration discharge home (consider phase of illness, social and geographic factors). GIVE ADVICE SHEET
• SEVERE – Move to Resus, Call for Paediatric Support.Nasal suction if required, Give humidified oxygen. Bronchodilators / Antibiotics / Hypertonic Saline NOT recommended

Reference: Guidance for the Management of Bronchiolitis in Children (June 2018)