bronchiolitis
BRONCHIOLITIS
Bronchiolitis is a clinical diagnosis preceding upper respiratory illness and/or rhinorrhea.
Signs of respiratory illness which may include wheezing, retractions, oxygen desaturation, color change, nasal flaring.
There is also presence of apnea especially in premature or low birthweight infants, signs of dehydration and exposure to persons with viral upper respiratory infections.
Symptoms are usually worst on the 3rd-5th day of illness and then improve gradually.

Monitoring

  • Cardiac & respiratory rate (RR) monitoring during the acute stage must be considered, when the risk for apnea and/or bradycardia is greatest
    • Once pulse & respiratory rate (RR) have stabilized, monitoring may be discontinued
  • Hourly oxygen saturation (SaO2) monitoring is recommended for patients with moderate bronchiolitis
  • <1 month old patients with history of apneic episodes & prematurity should be monitored for apnea
  • Continuous cardiorespiratory and oxygen saturation (SaO2) monitoring is recommended for patients with severe bronchiolitis
  • Spot pulse oximetry checks are preferable to continuous pulse oximetry
  • Mechanical monitoring devices for heart rate, respiraotry rate (RR) & oxygen saturation (SaO2) must be utilized discriminately, so that their use will not result in failure to discharge the patient from the hospital in a timely manner

Suctioning

  • Secretions should be suctioned regularly; before feeding, prior to each inhalation therapy, with presence of signs of upper airway obstruction, or as needed

Respiratory Syncytial Virus (RSV) Prevention

General Measures to Prevent Respiratory Syncytial Virus (RSV) Infection

  • Eliminate exposure to environmental tobacco smoke
  • Limit exposure to contagious settings and siblings eg day care centers
  • Emphasize hand washing
  • Stress the importance of exclusive breastfeeding for at least 6 months in lowering the risk of having respiratory syncytial virus (RSV)-related hospitalization
  • Advise on preventive medical therapies

Immunoprophylaxis

  • May be considered in high-risk patients
  • Reduces the frequency and total days of hospitalization for respiratory syncytial virus (RSV) infections in high-risk infants
  • Administered monthly from the beginning to the end of the respiratory syncytial virus (RSV) season
  • The respiratory syncytial virus (RSV) season may vary from country to country
    • In temperate climates, respiratory syncytial virus (RSV) typically begins in the fall months & lasts through to the spring
    • In tropical climates, respiratory syncytial virus (RSV) season usually coincides with the rainy season
  • Cost effectiveness of respiratory syncytial virus (RSV) prophylaxis depends on the patient’s risk for disease & the healthcare setting

The following groups will benefit most from respiratory syncytial virus (RSV) prophylaxis:

  • Children or infants <24 months of age who, in the last 6 months prior to the anticipated respiratory syncytial virus (RSV) season received treatment with any of the following:
    • Supplementary oxygen (O2), corticosteroids, bronchodilators or diuretics
  • Children <24 months of age who, in the last 6 months, received treatment for bronchopulmonary dysplasia
  • Infants born ≤35 weeks gestational age, who were discharged during, or 6 months old at the start of the respiratory syncytial virus (RSV) season
  • Premature infants <32 weeks age of gestation without chronic lung disease
  • Infants <2 years with chronic lung disease
  • Infants 32-35 weeks gestational age with ≥2 of the following risk factors:
    • School-aged siblings, child care attendees, environmental air pollutants exposure, congenital abnormalities of the airways, or severe neuromuscular disorder
  • Children or infants ≤24 months of age with hemodynamically significant congenital heart disease which includes children on medication to control congestive heart failure, have moderate to severe pulmonary hypertension, or have cyanotic heart disease

Palivizumab

  • Monoclonal antibody to the respiratory syncytial virus (RSV) F protein
  • Administration should be reserved for high-risk infants [congenital heart disease, chronic pulmonary disease of prematurity, born at <29 weeks age of gestation (AOG)] and children with chronic pulmonary disease of infancy continuously requiring corticosteroids or diuretics within 6 months of 2nd respiratory syncytial virus (RSV) season
    • Effective in reducing hospitalization rates and occurrence of severe respiratory disease in high-risk infants
  • Preferred for most high risk children because of ease of intramuscular (IM) administration and lack of interference with live virus vaccines, (eg measles-mumps-rubella & varicella)
  • Eligible infants/children should receive a maximum of 5 monthly doses during the respiratory syncytial virus (RSV) season

Respiratory Syncytial Virus-Intravenous Immunoglobulin (RSV-IVIG)

  • Provides some protection against other respiratory pathogens
  • May take the place of intravenous immunoglobulin (IVIG) during the respiratory syncytial virus (RSV) season for children with immunodeficiency who receive monthly intravenous immunoglobulin (IVIG)
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