Table 4

 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