Beatriz Morillo
Once diagnosed, the next step is to assess the severity, defined as those signs and symptoms associated with poor feeding and respiratory distress characterized by tachypnea, nasal flaring, and hipoxemia.
The parameters to focus on are:
a) Ability of the child to maintain an effective breathing- using clinical parameters and complementary tests, such as pulse oximetry or capillary/arterial blood gas in case of severe respiratory symptoms including apnoeas. To date, some clinical scores have been developed in an attempt to predict the course of the disease, but none has been validated to be used universally.
b) Ability of the child to maintain an adequate hydration- assessment of clinical signs of dehydration, fluid intake and diuresis, such as the presence of a wet nappy in the last 12 hours, with complementary tests if needed, as biochemistry or blood gas.
c) The presence of risk factors associated with a more severe presentation and higher mortality:
• Chronic lung disease, including bronchopulmonary dysplasia defined as preterm infants <32 weeks of gestation who require >21% oxygen for at least the first 28 days of life
• Haemodynamically significant congenital heart disease
• Chronological age, particularly under 3 months
• Premature birth, particularly under 32weeks
• Neuromuscular disorders
• Immunodeficiency

The diagnosis of acute bronchiolitis is clinical; an infant who presents with the above symptoms and physical examination in an epidemiological context doesn´t need further tests to be diagnosed.

The differential diagnosis is:
• Viral induce wheeze
• Asthma
• Infectious pneumonia
• Mucociliary clearance disorders: cystic fibrosis, primary ciliary dyskinesias, and bronchiectasis
• Anatomic abnormalities: congenital structural airway anomaly, extrinsic abnormalities resulting in compression
• Aspiration syndromes: gastroesophageal reflux disease, pharyngeal-swallow dysfunction

Some tests might be advisable to assess the degree of severity, the presence of complications or to rule out an alternative diagnosis.

Chest X ray shows hyperinflated lungs with patchy atelectasis. It is not advisable to be routinely done when the patients present a clear diagnosis of bronchiolitis, as the findings could be misleading of a bacterial pneumonia. However, it is recommended if the latter is suspected in the presence of high fever or focal crackles on auscultation. It can also show the presence of respiratory complications if worsening of the symptoms, such as pneumothorax, or in the case of congenital abnormalities.

Routine full blood count or biochemistry are not recommended. The most frequent findings are normal or high lymphocyte count with normal C reactive protein. In case of neutrophilia with high inflammatory markers, a bacterial infection should be suspected.
Arterial blood gas should be done in cases suggestive of respiratory failure.

Samples should not be routinely taken, as there is no increased benefit of identifying a specific viral etiology for the patient. It could be useful for epidemiological or isolation purposes.
There is no need for a sepsis evaluation in case the diagnosis of bronchiolitis is clear, as the presence of a concurrent bacterial infection is highly unlikely in these patients.

Bronchiolitis Bronchiolitis 02/13/2016
<< Bronchiolitis - Clinical Presentation Bronchiolitis Next Steps >>
ask a doctor
Ask a Doctor
Disclaimer: The information given by is provided by medical and paramedical & Health providers voluntarily for display & is meant only for informational purpose. The site does not guarantee the accuracy or authenticity of the information. Use of any information is solely at the user's own risk. The appearance of advertisement or product information in the various section in the website does not constitute an endorsement or approval by Pediatric Oncall of the quality or value of the said product or of claims made by its manufacturer.
0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0