Bronchiolitis in afya

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''Epidemiology''
most common cause of a serious LRTI in < 1yr olds (90% 1-9/12, peak 3-6/12) 
Maternal IgG protects newborns 
higher incidence in winter

''Basics''
acute bronchiolar inflammation
Respiratory syncytial virus (RSV) 75-80%  
SIGN guidelines 2006
other causes: mycoplasma, adenoviruses
may be secondary bacterial infection
more serious if bronchopulmonary dysplasia (e.g. Premature), congenital heart disease or cystic fibrosis

''Features''
coryzal symptoms (including mild fever) precede:
dry cough
increasing breathlessness
wheezing, fine inspiratory crackles (not always present)
feeding difficulties associated with increasing dyspnoea (admission)

SIGN suggested the following ''criteria'' for referral to hospital
poor feeding (< 50% normal)
lethargy
apnoea
respiratory rate > 70/min
nasal flaring or grunting
severe chest wall recession
cyanosis
oxygen saturation < 94%
uncertainty regarding diagnosis

''Investigation''
immunofluorescence of nasopharyngeal secretions may show RSV

''Management'' - supportive
humidified oxygen is given via a head box
PCM - not bronchodilators

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