Bronchiolitis is an epidemic and seasonal viral infection of the lower respiratory tract, characterized by obstruction of the bronchioles in children less than 2 years.
Respiratory syncytial virus (RSV) is responsible for 70% of cases of bronchiolitis. RSV transmission is direct inhalation of droplets (coughing, sneezing) and indirect contact with equipment and soiled hands of infected secretions.
In most cases, bronchiolitis is benign, it evolves towards spontaneous healing (with a possibility of recurrence) treatment is performed as an outpatient.
There are severe forms may develop life-threatening exhaustion infant or bacterial infection. Hospitalization is required when a child shows signs / severity criteria (10 to 20% of cases).
Clinical signs:
– Tachypnea, dyspnea, wheezing expiration, cough, hypersecretion (foam
congestion).
– On auscultation: expiratory wheezes brake with bilateral diffuse. Sometimes, fine crackles, diffuse, at the end of inspiration.
These signs are preceded by a rhinopharingite with dry cough within 24 to 72 hours, without fever or accompanied by a mild fever.
– Signs of severity:
• significant alteration in general health, toxic appearance (pale gray complexion)
• apnea, cyanosis (to look at the lips, oral mucosa, nails)
• control signs (beating wings of the nose, drawing sternal / shoulder)
• Anxiety and agitation (hypoxia), consciousness disorders
• Respiratory rate> 60 / min
• Reduced signs of struggle and bradypnea (respiratory rate <30 / min and 1 and <20 / min prior 3 years, last).
Be careful not to attribute these symptoms to clinical improvement.
• Sweating, resting tachycardia and absence of fever
• Silence on auscultation (severe bronchial spasm)
• Difficulty drink or breastfeed (poor exercise tolerance)
Treatment:
Treatment is symptomatic. Signs of obstruction last for ten days; cough may last two weeks more.
Children who meet the following criteria are hospitalized:
– Presence of a sign of seriousness
– Pre-existing pathology (heart, lung, malnutrition, HIV, etc.)
Hospitalization should be considered case by case in the following situations:
– Acute pathology associated (gastroenteritis, bacterial infection, etc.)
– Age less than 3 months.
In other cases, the child can be treated at home, showing parents how to treat child and what signs of seriousness which should lead to re-consult.
Outpatient:
– Nasopharyngeal wash in 0.9% NaCl before feedings / meal (show the technique to the mother) “nasal instillations of sodium chloride 0.9% per nostril nostril, the child supine, head on the side “.
– Splitting feedings to reduce vomiting during coughing.
– Increase water intake in case of fever and / or important secretions.
– Treatment of fever.
– Avoid all unnecessary handling.
Hospitalization:
– In all cases :
• Installation of child-reclining position (± 30 °).
• Washing of the nasopharynx, splitting the feedings, fever treatment as an outpatient.
• mild oropharyngeal aspirations if necessary.
• Water intake: 80 to 100 ml / kg / day + 20 to 25 ml / kg / day in case of high fever or very productive bronchial secretions.
– Depending on the symptoms:
• humidified nasal Oxygen (1 or 2 liters / min).
• In case of severe fatigue at feeding or vomiting, passing the water intake or by gastric tube (frequent contributions, small volumes), or IV, for the shortest possible duration. Do not breastfeed or oral feeding to severely polypnéique child, but not to prolong the gavage (difficulty breathing) or infusion.
• bronchodilator treatment: treatment can be proposed as a test (salbutamol inhaler: 2-3 puffs through a spacer, renewed 2 times 30 minutes apart).
If the test is effective, the treatment is continued (2-3 puffs every 6 hours in the acute phase and then gradually decrease as the clinical course); if the test is failed, the treatment is discontinued.
• Antibiotics are not indicated, except in cases of suspicion of infectious complications such as bacterial pneumonia.
Prevention and control:
Nosocomial transmission of the virus is high:
– Grouping children with bronchiolitis away from other children (cohorting).
– The hand transmission of the virus being predominant, the most important prevention measure is hand washing after contact with patients and objects or surfaces in contact with patients, in which the virus survives several hours.
– Moreover, the staff should wear gowns, gloves, surgical masks during contact with patients.
