Prevalace of bronchiolitis in a tertiary care hospital

1. CLINICOPATHOLOGICAL
CONFERENCE
DR. ARUSA FAROOQ
PGR PAEDS

2. Case presentation
Gender : Male
Age : 6 month
Weight : 5 kg

3. Presenting complaint
• Fever , flu and cough ----- 3 days
• Difficulty in breathing -----1 day

4. Continued
• Past medical history: first episode, no previous history
• Family history : Insignificant

5. On examination
• Febrile 100 F , Heart rate 145/min
• R/R 65/min , Spo2 91% in Room air
• Irritable
• B/L reduced air entry + B/L wheeze+ crepts
• Subcostal recessions
• S1+S2+0
• Abdomen soft + non distended
• Liver palpable 2 cm below right costal margin

6. Continued
• D/D:
a: Bronchiolitis
b: Pneumonia
c: Hyperreative airway disease
• Provisional Dx: Bronchiolitis

7. Video

8. Investigations
• CBC : TLC 13000 with 30%polys and 60 % lymphos
• CRP: 4
• ABGs: pH 7.4, PO2 106, PCO2 21.8(with O2)
• Chest X ray: B/L scattered infiltrates with mild
hyperinflation

9. Chest X ray

10. Treatment
• Supplemental Oxygen inhalation via nasal prongs at
2L/min
• Kept NPO
• IV fluids
• Nebulization:
a: Hypertonic saline 3%
b: Inhaled salbutamol+ Beclomethasone
• IV Corticosteroids

11. continued
• Patient distress worsened
• Shifted to CPAP with flow 4L/min and FiO2 50%
• Antibiotics started
• Respiratory support gradually weaned off and distress
improved after 4 days so shifted to ward

12. Statistics
• Data from Nov 2021- Jan 2022
Total no of pts
with bronchiolitis
516
Pt admitted in
PICU 53

13. Age and Gender
• Age :
< 6 months 60%
> 6 months 40%
• Gender :
Male 45%
Female 55%

14. continued
Duration of illness:
<5 days in 100% patients
Length of stay:
<7 days 66%
>7 days 34%

15. continued
Investigations:
a: CBC 100%
b: CRP 70%
c: ABGs 80%
d: Chest X ray 100%

16. Treatment
Treatment Percentage
Nebulization
3% hypertonic saline 80%
Salbutamol 70%
Ipratropium 60%
Salbutamol +
beclomethasone
20%
Antibiotics 87%
IV steroids 60%
Montelukast 20%
MgSO4 5%

17. ACUTE BRONCHIOLITIS
DR. HINA NASIR
Senior Registrar Pediatric Medicine
Shalamar Institute of Health Sciences

18. Overview
• Bronchiolitis is an acute inflammatory injury of the
bronchioles that is usually caused by a viral infection
• Children younger than 2 years, with a peak in infants
aged 3-6 months.
• Most common cause of lower respiratory tract infection in
the first year of life.

19. Etiology
• RSV- more than 50% of cases.
• Para influenza, Adenovirus, Rhinovirus
• human metapneumovirus and human bocavirus
• Mycoplasma
• Concurrent infection with pertussis has been described

20. Risk factors
• Boys < 1 year
• Top fed infants
• Crowded conditions
• Infants with young mothers
• Premature, low birth weight infants
• Immuncompromised children
• Chronic lung disease
• Congenital Heart Disease

21. Pathophysiology
• Bronchiolar obstruction with edema, mucus, and cellular
debris
• Bronchiolar wall thickening affects airflow in small airways
• Early air trapping & overinflation
• Trapped distal air will be resorbed resulting in atelectasis.
• Ventilation–perfusion mismatch

22. Immune System
• Type 1 allergic reactions_immunoglobulin E (IgE)
• Breastfed Infants_immunoglobulin A (IgA)_Protetctive
• Lymphocytic infiltration
• Cytokines and chemokines,

23. Transmission
• Direct contact with respiratory secretions, airborne
droplets, and fomites.
• October/November and early April, peaking in January or
February.

24. Clinical Manifestation
• Bronchiolitis usually develops following one to three days
of common cold symptoms, including
• Nasal congestion and discharge
• Cough
• Fever (temperature higher than 100.4°F or 38°C)
• Decreased appetite

25. Clinical Manifestation
• As the infection progresses to the lower airways, other
symptoms develop, including:
• Breathing Difficulty
• Wheezing
• Persistent coughing
• Difficulty feeding

26. Clinical Manifestation
• Severe cases progress to
• Respiratory distress with tachypnea, nasal flaring,
retractions, grunting, irritability, and, possibly, cyanosis.
• Apnea may be more prominent in very young infants (<2
mo old) or former premature infants.

27. Diagnosis
• Clinical Diagnosis
• Chest radiography can reveal hyperinflated lungs with
patchy atelectasis
• CBC- normal.
• Viral testing
• polymerase chain reaction,
• rapid immunofluorescence
• viral culture

28. Treatment
• Supportive
• Humidified oxygen
• Airway Positioning
• Maintain nutrition and hydration
• Frequent suctioning of nasal and oral secretions
• High-flow nasal cannula therapy

29. Treatment
• Hand decontamination
• Infants should not be exposed to passive smoking
• Breastfeeding is recommended

30. Treatment
• Continuous positive airway pressure (CPAP) may improve
respiratory failure and help avoid intubation of patients in
the Intensive Care Unit.
• Mechanical ventilation
• ECMO

31. Recent Advances
• Nebulized hypertonic saline
• Aerosolized Ribavirin
• Leukotriene receptor antagonists (Montelukast)
• Zinc

32. Recent Advances
• Combined therapy with nebulized epinephrine and
dexamethasone
• Bronchodilators
• Corticosteroids
• Antibiotics
• Magnesium Sulphate

33. Recent Advances
• Heliox (Helium & Oxygen)
• Recombinant human DNAse
• Surfactant
• Inhaled Furosemide
• Palivizumab prophylaxis
• Immunotherapies

34. BRONCHIOLITIS
Prof. Muhammad Nadeem Hameed
Pediatrics Dept. SMDC

36. DISTRESS
CHILD
Parents
Physician

37. Diagnosis and Admission
• Case Definition
• Admission Criteria

38. IMNCI Guidelines

39. Course of Disease
Failure to Predict
for need of
Supportive Care

40. Diagnostic Tests
•Chest Radiographs – not
recommended
• Poor Correlation with severity of disease
and risk of progression
• Similar appearance of Atelactasis
/infilterates

41. Treatm
ent
EBM PRAC
TICE

42. Antimicrobials
• Chances of bacterial etiology 0.6 %
• Superadded infection is more fictional
experience
• Prophylactic administration is not at all
beneficial

44. •Worldwide Annual
Breakdown and NO
vaccine