Suggested guideline for infants admitted with bronchiolitis
| FBC, full blood count; FIo2, fraction of inspired oxygen; RR, respiratory rate; RSV, respiratory syncitial virus; Sao2, arterial oxygen saturation; U&E, urea and electrolytes. | |
| Investigations | Not usually required |
| Nasopharyngeal aspirate: not required if diagnosis clear and no need for cohort nursing | |
| FBC, U&E, blood cultures: only consider if siting an intravenous (iv) line | |
| Chest x ray: only if deteriorating or requiring ventilatory support | |
| Arterial blood gas: only if tiring or if FIo2 >40% | |
| Prevention of cross infection | Strict handwashing for staff and family |
| Isolate or cohort nurse | |
| If nursing in cohort, nurse RSV positive babies together | |
| Oxygen | To maintain Sao2 >92% humidified |
| Give via headbox in infants < 3 months of age to avoid blocking nostril | |
| Fluids | Small, frequent feeds 2–3 hourly |
| Orally if no increased oxygen requirements with feeds and RR <50 | |
| Via orogastric or nasogastric if RR 50–60, and respiratory distress does not increase with feeds | |
| Give iv fluids at 2/3 maintenance if RR >60 or respiratory distress increases with gastric feeds | |
| Bronchodilators | Consider giving trial of ipratropium 125 μg. Reassess 10–20 mins after administration and only continue if clear benefit |
| Ventilatory support | Consider if increasing oxygen requirements, increasing respiratory distress, fatigue, recurrent apnoea, arterial blood gases deteriorating, agitation, peripheral shut down |