Bronchiolitis in children

1. Bronchiolitis
Epidemiology, Etiology
Clinical Features, Complications, Management
Prognosis and Prevention
Prof. Imran Iqbal
Fellowship in Pediatric Neurology (Australia)
Prof of Paediatrics (2003-2018)
Prof of Pediatrics Emeritus, CHICH
Prof of Pediatrics, CIMS
Multan, Pakistan

2. (God speaking to Prophet Muhammad (PBUH)
And, in fact, You have a great moral character
Al Quran surah Qalam 68:5

3. Case scenario
• A 6 months old baby presents in emergency with
runny nose and cough and for the last 2 days. Baby
is feeding much less than before.
• On examination, baby is having frequent dry cough.
His temperature is 99.5 F. His respiration is 60 per
minute and chest indrawing is present. On
auscultation of chest, diffuse expiratory rhonchi
and fine inspiratory crepitations are bilaterally
audible.
• What is your diagnosis ?

4. Causes of Wheezing in infancy
• COMMON CAUSES
• Bronchiolitis
• Viral bronchitis
• Asthma
• Pneumonia (viral + bacterial infection)
• RARE CAUSES
• GERD
• Heart failure
• Cystic fibrosis
• Immunodeficiency
• Ciliary dyskinesia
• Congenital lobar emphysema

5. Bronchiolitis - Epidemiology
• Seen in infants up to 2 years of age
• Occurs in epidemics usually in winter months
• Can be mild or severe
• Resolves in 10 – 14 days

6. Bronchiolitis - Etiology
• Caused by RSV (Respiratory Syncytial Virus)
• Human metapneumo virus
• Parainfluenza virus

7. Bronchiolitis - Pathogenesis
• Mucosal edema
• Mucus secretion
• Cell necrosis, cell debris
• Bronchiolar obstruction
• Hyperinflation
• Atelectasis

8. Bronchiolitis - Clinical Features
• Runny nose
• Cough
• Fever – low grade
• Poor feeding
• Fast breathing
• Chest indrawing
• Prolonged expiration
• Wheezing
• Expiratory rhonchi and inspiratory crackles

9. Diagnosis

11. Investigations
• CBC
• CRP
• X-ray Chest
• HRCT chest
• Nasopharyngeal Swab for RSV – antigen test
• NPS for viral / bacterial PCR tests

12. Chest radiography

13. Complications
• Pneumonia – viral / bacterial
• Pneumothorax
• Apnea
• Hypoxia
• Respiratory Failure

14. Assessment of Severity

15. MANAGEMENT
• SUPPORTIVE MANAGEMENT IS REQUIRED
• IV fluids
• Oxygen
• Clearance of secretions
• NEBULISATION:
• Ipratropium and/or Salbutamol
• Steroids
• Hypertonic saline
• Antibiotics – if superadded bacterial infection
• Hospitalization (not feeding OR lethargy OR hypoxia)

16. Prevention

17. Prevention of Bronchiolitis
• Breastfeeding, Nutrition, Micronutrients
• Masks and Social Distancing
• Hand washing,
• Control of smoking, air pollution, cold air

18. Thank You