This is a new guideline from Nice on diagnosing and managing bronchiolitis. It really doesn’t add much new as it mainly lays out criteria for referral and this is just around recognition of a sick child. I’ve outlined a few interesting points.
- Symptoms usually peak at 3 – 5d.
- 90% have recovered from the cough by 3w.
- Fever is common (30%) in babies but be suspicious of pneumonia if the temperature is over 39.
- Ask about apnoea. Recurrent episodes are a sign of severity. In young babies (eg 6w or under) this can be the only presenting feature.
- Don’t use salbutamol in the treatment of bronchiolitis.
- They’ve outlined very specific red flags to warn parents of.
- Increased work breathing (eg grunting, nasal flaring or recession).
- Apnoea or cyanosis.
- Reduced fluid intake (eg 50 – 75% of normal) or no wet nappy for 12 hrs.
- Exhaustion