Suggested guideline for management of outpatient management of bronchiolitis
| Management depends on severity | |
|---|---|
| Mild (fulfils criteria below) | |
| Minimal respiratory distress only | Oxygen saturation >95% in air |
| Feeding well | No risk factors |
| At least 3 months of age | Respiratory rate <50 |
| No social concerns | Parents happy for discharge |
| No specific treatment or investigations necessary. Can be discharged. Advise parents to give small, frequent feeds. Advise them to return promptly if there is deterioration in symptoms, such as inability to feed or infant working harder | |
| Moderate (fulfils criteria below) | |
| Mild–moderate respiratory distress | Oxygen saturation 92–95% in air |
| Respiratory rate 50–70 | No risk factors |
| Refer to paediatric team. Needs a period of assessment, including serial assessment of respiratory distress, oxygen saturations, and monitoring of feeds. | |
| Consider trial of two doses of adrenaline 3 ml 1:1000 nebulised 30 minutes apart (observe for at least 2 hours following administration of adrenaline) | |
| If feeding satisfactory and respiratory distress improved, discharge with advice to return promptly if there is deterioration in symptoms, such as inability to feed or infant working harder. Advise small, frequent feeds | |
| Severe (fulfils any of the following criteria) | |
| Moderate–severe respiratory distress | Oxygen saturation <92% |
| Risk factors (table 1) | Respiratory rate >70 |
| Poor feeding | Looks ill/toxic |
| Apnoea | Social concerns |
| Admit | |