← Diagnosis and Management Guides
Bronchiolitis
Key considerations: Pertussis, Foreign body, Congenital heart disease
Cannot miss
- Pertussis
- Foreign body
- Congenital heart disease
- Myocarditis
Likely diagnoses
- RSV bronchiolitis
- Rhinovirus bronchiolitis
- Other viral bronchiolitis
Red flags
- Age <2 months
- Apnea
- Severe respiratory distress
- SpO2 <90% persistently
- Prematurity <32 weeks
Workup
- history: URI symptoms progressing to cough, wheeze, feeding difficulty, age <2yr; exam: Wheezing, crackles, tachypnea, retractions, nasal flaring, feeding assessment; labs: RSV/viral testing (isolation purposes, not treatment-changing); CBC rarely needed; imaging: CXR NOT routinely recommended (leads to unnecessary antibiotics); bedside: Continuous SpO2
Management
- immediate: Nasal suctioning; Supplemental O2 if SpO2 persistently <90%; High-flow nasal cannula if escalation needed; general: Supportive care is the cornerstone — NO albuterol, NO steroids, NO antibiotics unless bacterial co-infection; Maintain hydration (PO preferred, NG if needed); Trial of suctioning before any intervention
Disposition
- admit: Age <2 months, apnea, dehydration, sustained hypoxia, respiratory distress; discharge: Able to feed adequately, SpO2 >90% on room air, reliable caregivers; consults: PICU if HFNC or respiratory failure
Clinical pearls
- AAP guidelines: do NOT use albuterol, epinephrine, hypertonic saline, or steroids for bronchiolitis
- CXR in bronchiolitis does NOT improve outcomes and increases antibiotic use
Source and review
- AAP Bronchiolitis Guidelines 2014 (reaffirmed 2023). Last reviewed: 2024-11-01