key: cord-1002384-q9b38ekq
authors: Gill, Peter J; Chanchlani, Neil; Mahant, Sanjay
title: Bronchiolitis
date: 2022-02-14
journal: CMAJ
DOI: 10.1503/cmaj.211810
sha: 41ee3efd1a8985e68c92eeeaaed11858a24e05a6
doc_id: 1002384
cord_uid: q9b38ekq

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Most children present with low-grade fever, tachypnea, chest wall retractions and reduced oral intake, with crackles and wheeze bilaterally. 1, 4 Risk factors for severe bronchiolitis include cardiorespiratory, neuromuscular or immunodeficiency comorbidities; age 3 months or younger; and prematurity. 1, 4 Bacterial pneumonia should be considered if fever is 39°C or higher or there are unilateral chest signs on auscultation. 4 

Nasopharyngeal swabs do not alter management but may be used to cohort children in hospital. 1 Chest radiographs and blood tests are not indicated unless the presentation is severe (i.e., requiring intensive care) or the diagnosis is unclear. 1,4 Children should be referred for possible admission if there is moderate increased work in breathing, coughing with sustained vomiting, signs of dehydration, or oxygen saturations less than 90% in room air. 1,4

Oxygen should be administered to maintain saturations at 90% or higher, including while the patient is asleep. Bronchodilators, inhaled epinephrine, antibiotics, hypertonic saline and corticosteroids are not recommended. 1, 4 The patient's nares should be suctioned superficially if excessive secretions impede breathing or feeding. 1, 4 Compared with intravenous fluids, nasogastric tube hydration avoids cannulation, allows enteral nutrition and reduces irritability due to hunger. 5

Although symptoms peak between 3 and 5 days from onset, there is no association between day of illness at admission and hospital length of stay. 6 Cough will usually resolve within 2 weeks, but about 10% of children may have persistent cough for 3 weeks or longer. Practice | Five things to know about ...

Peter J. Gill 

Acute Care Committee DT and HSC. Bronchiolitis: recommendations for diagnosis, monitoring and management of children one to 24 months of age

Did emergency department visits in infants and young children increase in the last decade? An Ontario, Canada study

Potential resurgence of respiratory syncytial virus in Canada

London (UK): National Institute for Health and Care Excellence (NICE); updated

Parenteral versus enteral fluid therapy for children hospitalised with bronchiolitis

Day of illness and outcomes in bronchiolitis hospitalizations

This is an Open Access article distributed in accordance with the terms of the Creative Commons Attribution (CC BY-NC-ND 4.0) licence, which permits use, distribution and reproduction in any medium, provided that the original publication is properly cited, the use is noncommercial (i.e., research or educational use), and no modifications or adaptations are made. See: https://creativecommons.org/ licenses/by-nc-nd/4.0/ Disclaimer: Neil Chanchlani is an associate editor for CMAJ and was not involved in the editorial decision-making process for this article.Correspondence to: Sanjay Mahant, sanjay.mahant@sickkids.ca