3 month old baby Fathima Sampra presented with cough for 7 days. The cough was worse when lying down and caused waking at night. On examination, the baby had increased respiratory rate and bilateral crepitation at the lung bases. Differential diagnoses included bronchiolitis, bronchial asthma, and pneumonia. Treatment involved nebulized ipratropium and hypertonic saline, along with saline nasal drops. Oxygen supplementation was not needed as the baby's saturation was normal.

1. BRONCHIOLITIS
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2. History Presentation.
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3.  3 months old baby Fathima Sampra presenting with cough
for 7 days duration.
 She had been apparently well 7 days ago and had developed
acute onset cough .It had been gradually increased.
 On the 2nd day she had developed productive cough ,it was
scanty in amount whitish in colour and there was no smell
,material and blood discharge in sputum.
 Cough was mostly presented when baby was lying on the
bed ,baby had been woken up in night with cough in several
days, upper respiratory sound present while sleeping.
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4.  No associated wheezing attacks ,fever, runny nose, sneezing,
ear and throat discharge, and skin rashes.
 There was no change in breast feeding ,behavior and no
excessive crying.
 Baby did not crying while passing urine and urine was not
blood contain. Baby had passed stool as usual but stools were
loose in consistency.
 2nd day baby had been taken to a General Practitioner .Same
day symptoms had subsided with the medication.
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5.  4th day baby had been taken to hospital and nebulization had
been done, but not due to complete recovery baby had got
admitted to hospital
 No history of foreign body inhalation, no past history of
congenital heart disease.
 There were no recent history of fever or above symptoms in
mother or family members.
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6. Systemic Inquiry
• CVS- No palpitation, No ankle swelling.
• GU- No colour change of urine ,No frequency of urine
passing, No poor flow.
• GI- No vomiting, No colour change of stools.
• CNS-No convulsion, No loss of consciousness.
• ENT-No ear or nasal discharge, no nasal bleeding.
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7. Past Medical History
• At 2 month of age she has had cough for 2-3 days and
completely recover after taking medication.
• At 1 month of age she has passed watery stool for 3 days and
it was resolve after taking medication.
• There was no records of hospital admission.
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Past Surgical History
• No significant

8. Birth History
• Baby had been born via normal vaginal delivery at 40 weeks
of POA with a bw of 2.8kg.
• In antenatal period there was no any complications and
mother had taken all the supplements on time.
• On 3rd day of delivery baby had presented with yellowish
discoloration of eyes, and it was resolved its own.
• The day after delivery they have discharge and there was no
NICU admission.
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9. Nutrition History
• Baby is on exclussive breast fed 3 hourly for about 15-20
minutes.(demand breast feeding )
• Breast feeding had been started immediately after birth.
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10. Developmental history
• She has achieved the respective milestones on time.
• Now she ,
Turns head to sounds,
Make eye contact,
Smiles with others,
Move limbs and lift the head in prone position
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11. Immunization History
• All vaccines had been given up to date according to EPI
schedule from the government clinics. Last vaccine given 2nd
month of age (Pentavalent, OPV1st dose) After the last
vaccine baby had developed mild fever and it has been
resolved its own.
Drug History
• Not on any long term drugs.
Allergic history
• No known food or drug allergies.
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12. Family History
• Not a child of consanguineous marriage.
• No family history of bronchial asthma.
Social History
• She lives with her 2 sister parent and grand parent .They have
extended family support .
• Mother is 47 years old and she is a house wife .Father is 55
years old and he is a businessmen.
• Monthly income 50000/= financially stable .
• Both parent have studied up to the advance levels.
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13. Baby is not exposure to the cigarette smoke , No pets at home,
Home environment is clean no dust .They change bedsheets
once a week and net once a month.
They do not use fire wood for cooking . Nearest hospital is
Dompe hospital, They have their own vehicle .
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14. Examination
• General Examination
 Weight-6kg
 Length-61kg
 OFC-4cm
 MAC-14cm
• Baby was mild ill looking.
• Adequate growth.
• Comfortably lying down, alert and responsive.
• Yellow canula was on the right hand.
• Afebrile-98.6F.
• No dyspneic features.
• No dysmorphic features- No low set ears, No flat nasal bridge, no flat
occiput.
• Eyes-Not sunken ,No pallor, No icterous, Tear present.
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15. • Nasal cavity-No nasal polyps, No nasal septal defect, No nasal flaring.
• Mouth- No central cyanosis, No high arch palate.
• Hand- BCG scar presented as red lump.
No clubbing.
No peripheral cyanosis.
• Leg- No ankle swelling.
No peripheral cyanosis or clubbing.
• Neck- No palpable lymph node.
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16. Respiratory system
RR-32 bpm
Inspection-
• No surgical scars on the chest wall
• No chest wall deformities
• Intercostal and subcostal Chest recessions present
• The Chest moved symmetrically with respiration
Palpation-
• The trachea was centrally located.
• The Chest expansion was symmetrical bilaterally.
• Apex beat was palpable at 5th intercostal space , Midclavicular line.
• Vocal fremitus-normal & equal on both sides.
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17. Percussion
• Resonance bilaterally .
Auscultation
• Bilateral crepitation are present at the lung bases.
Cardiovascular system
Pulse-101 ppm regular rhythm normal rate, no radial radial delay
All the peripheral pulse were felt
Inspection
• No surgical scars on the chest wall.
• No chest wall deformities.
• No Visible pulsation
Palpation
• Apex beat was palpable at 4th intercostal space , Midclavicular line.
• No parasternal heave.
• No thrills .
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18. Auscultation
• First and second heart sounds were heard.
• No additional heart sounds or murmurs.
Abdominal examination
Inspection-
• No abdominal distension
• No scars
• No visible pulsations
• Umbilicus is flat
Palpation-
• Abdomen was soft and non tender
• No masses or tender areas on superficially or deep palpation
• Has nor felt lower border of liver and spleen
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19. Percussion-
• Normal liver and spleen dullness present
• No free fluid
Auscultation-
• Normal bowel sounds present
CNS
Cranial nerves –
• Baby was alert and responsive
• Make eye contact
• Turns head to sound
• Smiles
• Uvula was centrally placed
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20. Motor system-
Inspection
• Upper and lower limb symmetrical
• No muscle wasting
• No abnormal movements and posture
• No gross deformity
• No surgical scars
• No fasciculation
Muscle tone- Muscle tone of upper and lower limb was normal
Muscle power- The power of all muscles tested in the upper and lower
limbs were normal, with grade 5/5
Reflexes- The reflexes of upper and lower limbs were present
with normal intensity.
Babinski reflex was negative
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21. Summary
3 month old baby presented with cough for 7 days duration.
Baby had been woken up in night due to cough and stridor
present while sleeping . Cough was a productive cough,sputum
was scanty in amount whitish in colour and there was no smell
,material or blood stain.
On general examination temperature was 98.6F afebrile and no
dyspneic and cyanosis features. On res examination RR-32
intercostal and subcostal chest recessions and bilateral
crepitation at the lung bases were presented.
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22. Problem list
• Present of cough sputum production and features of apnea
mostly respiratory tract infection
• Passing loose stools may be due to viral infection
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23. Differential Diagnosis
• Bronchiolitis.
• Bronchial asthma.
• Pneumonia.
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24. Management
• Investigation
For children with mild bronchiolitis, no
investigations are indicated, since they will not
influence the management.
For moderate to severe infection, investigations
such as pulse oximetry, full blood count and
chest radiograph may be considered
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25. Management
Supportive therapy and oxygen supplementation remains the mainstay of
treatment
• Nebulized
 Ipratropium 0.25 ml.
 Hypertonic saline 2 ml.
4 hourly alternatively.
• Saline nasal drop 4 hourly. –(Done)
• Humidified oxygen is administered via face mask (4L/min) or
nasal prongs (2L/min) if saturation is less than 92% to
overcome the hypoxia- (Not done for this baby )
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