4.7 Pediatric Broncholitis - Tice

im so tired

bronchiolitis is a clinical syndrome of respiratory distress and it is most common in children aged…

2 and under

bronchiolitis typically has _____ respiratory symptoms like rhinorrhea

upper

bronchiolitis is typically followed by a _____ infection, then inflammation in the _____

lower respiratory

lungs

bronchiolitis —> lower resp infection —> inflammation in the lungs—> ______ (symptoms)

wheezing

cracking

rales

bronchiolitis can occur with a____ or _____ with a viral pathogen

primary infection

reinfection

peak incidence of bronchiolitis occurs in which age

2-6 months

symptoms of bronchiolitis include…

inflammation

cell death

ciliary disruption

peribronchiolar lymphocytic infiltration

edema

mucus

sloughed epithelial cells

the symptoms of bronchiolitis lead to…

obstructed small airways and atelectasis

What is the most common cause of bronchiolitis?

RSV

What is the second most common cause of bronchiolitis?

Rhinovirus

When does RSV bronchiolitis typically occur?

Late fall & winter

temperate climates

rainy season

tropical and semitropical climates

What are the most high-yield risk factors for severe bronchiolitis?

• Prematurity (<36 weeks)

• Very young age (<12 weeks)

• Chronic lung disease

• Congenital heart disease

• Immunodeficiency

What environmental factors increase risk of severe bronchiolitis?

• Passive smoking exposure

• Crowded household

• Daycare attendance

What timing or exposure-related factors increase bronchiolitis severity risk?

• Born ~2 months before or after RSV season

• Concurrent birth siblings

• Older siblings

What underlying medical conditions increase risk of severe bronchiolitis?

• Chronic pulmonary disease

• Congenital heart disease

• Immunodeficiency

• Neurologic disease

• Airway abnormalities

What respiratory signs are seen in bronchiolitis?

increased respiratory rate

Retractions

Wheezing

Crackles

clinical features of bronchiolitis include…

respiratory distress

fever

cough

What type of fever is typically seen in bronchiolitis?

Low-grade fever (<38.3°C / 101°F)

What is the typical recovery course for bronchiolitis?

Most children recover within ~28 days (if not hospitalized)

How is bronchiolitis diagnosed?

Clinically

What are the main clinical features used to diagnose bronchiolitis?

viral upper resp prodrome then an increased resp effort with with or without crackles

mostly in children under 2 yrs old

increased resp effort signs

tachypnea

nasal flaring

retractions

What tests are NOT routinely needed to diagnose bronchiolitis?

CXR and labs

When might CXR and labs be used in bronchiolitis?

only to evaluate the possibilty of secondary bacterial infection, complications and other conditions

How is non-severe bronchiolitis managed?

outpt and supportive care only

What supportive care is used in bronchiolitis?

• Maintain adequate hydration

• Nasal suctioning (relieve congestion)

• Monitor for disease progression

Are medications routinely used in non-severe bronchiolitis?

nah fam

What OTC medications should be avoided in bronchiolitis?

Decongestants

Cough medications

When does bronchiolitis typically peak?

day 3-5 of illness

What anticipatory guidance should be given for bronchiolitis?

• Expected clinical course

• Nasal suctioning techniques

• Monitor fluid intake/output

• When to return for care

• Infection prevention strategies

When should a patient with bronchiolitis return for medical care?

apnea

increased resp rate

decreased fluid intake

cyanosis

lethargy

signs of dehyrdration

bronchiolitis is considered severe if any of the following are present

• Persistently increased respiratory effort (on repeated exams ≥15 min apart)

• Hypoxemia (SpO₂ < 95%)

• Apnea

• Acute respiratory failure

What oxygen saturation defines hypoxemia in bronchiolitis?

SpO₂ < 95%

What is the general indication for hospitalization in bronchiolitis?

Moderate to severe disease or inability to safely manage at home

What clinical findings indicate hospitalization for bronchiolitis?

• Toxic appearance

• Poor feeding

• Lethargy

• Dehydration

What signs indicate moderate to severe respiratory distress requiring hospitalization?

• Nasal flaring

• Intercostal, subcostal, or suprasternal retractions

• Respiratory rate > 70 breaths/min

• Dyspnea

• Cyanosis

What severe findings require hospitalization in bronchiolitis?

• Apnea

• Hypoxemia ± hypercapnia

What social factor may require hospitalization in bronchiolitis?

Parents unable to care for child at home

What are the initial priorities in the ER for severe bronchiolitis?

• Stabilize respiratory status

• Stabilize fluid status

• Determine appropriate level of care

When are bronchodilators used in bronchiolitis?

and provide examples

• 1-time trial ONLY

• Reserved for severe disease

• Examples: albuterol, epinephrine

What treatments are NOT recommended in bronchiolitis?

Nebulized hypertonic saline

Glucocorticoids

What supportive care is provided inpatient for bronchiolitis?

Monitor fluid intake/output

Respiratory support

Nasal suctioning

What is the oxygen goal in bronchiolitis?

SpO₂ > 90–92%

What advanced respiratory intervention may be required in severe bronchiolitis?

endotracheal intubation

Are bronchodilators routinely used in bronchiolitis?

no

What is Enflonsia (clesrovimab) used for?

RSV prevention in infants

What is the dosing of Enflonsia?

105 mg IM x1 dose

How long does Enflonsia protect against RSV?

5 months

Which infants should receive Enflonsia:

1. infants born during RSV season

2. infants born outside season

1. give at birth

2. give before the season starts

When is an additional dose of Enflonsia needed?

After cardiac surgery with cardiopulmonary bypass

What are the two main RSV prevention strategies discussed?

Nirsevimab (Beyfortus)

Abrysvo (RSV vaccine)

population target for

1. Beyfortus

2. Abrysvo

1. infant

2. mother

What is nirsevimab (Beyfortus) used for?

RSV prevention in infants

What is Abrysvo used for?

RSV vaccine given during pregnancy to protect the infant

When should Abrysvo be given during pregnancy?

32 weeks 0 days → 36 weeks 6 days gestation

During what months is Abrysvo given in the U.S.?

September through January

should Abrysvo be given if the mother previously had RSV infection?

YES — give regardless of prior RSV infection

What is the purpose of maternal RSV vaccination?

to provide passive immunity to the infant

When should an infant receive nirsevimab if the mother received Abrysvo?

If the maternal vaccine was given <14 days before birth → infant SHOULD receive nirsevimab

When does an infant NOT need nirsevimab after maternal RSV vaccination?

If the vaccine was given ≥14 days before birth → infant is protected → no nirsevimab needed

What happened to palivizumab (Synagis)?

Discontinued that hoe