University Hospital of Wales Paediatric Intensive Care Unit Guideline Printed on Wed 23-jul-08
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Last updated September 28, 2010 12:51 PM

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University Hospital of Wales Heath Park
Cardiff
CF14 4XW
02920 747747

Bronchiolitis


Indication for intubation is based on clinical features rather than blood gas results.

Differential diagnosis

Bronchiolitis is so common over the winter months it can be easy to forget that there are other diagnostic possibilities in infants presenting with respiratory failure.

Differential diagnosis includes immunodeficiency (FTT, diarrhoea, lymphopaenia), cystic fibrosis (FTT, diarrhoea), pertussis (marked lymphocytosis) and TAPVC (left sided heart failure) or other congenital heart disease (murmur, refractory hypoxia).

Remember to look for evidence of failure to thrive, history of diarrhoea and evidence of heart failre.

Antibiotics are only if indicated by positive cultures or sepsis syndrome.
NPA and NBL for all ventilated patients - samples sent for bacteriology, virology

NBL to look for Pneumocystis should be requested if there is a suspicion of immunodeficiency (e.g. lymphopaenia)

If the presentation was with apnoea, and RSV bronchiolitis is not confirmed, an LP should be performed (in the absence of contraindications)

Feed enterally as soon as possible