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Bronchiolitis — UKMLA MCQ

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ModeratePaediatricsBronchiolitisUKMLAPARAMRCGP AKTMRCEM SBA

A previously well 3-month-old infant is seen in general practice with clinically diagnosed bronchiolitis. The respiratory rate is 62 breaths/min and oxygen saturation is persistently 90% while breathing air, confirmed using an appropriately positioned infant probe. The infant is taking approximately half the usual volume of milk. There is no apnoea, central cyanosis, grunting or marked chest recession. What is the most appropriate next action?

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Correct answer: C — Arrange same-day paediatric hospital assessment

The correct answer is C. NICE advises considering hospital referral for bronchiolitis when the respiratory rate is over 60/min, oral intake has fallen to 50–75% of usual, or oxygen saturation is persistently below 92% in air. This infant meets all three referral criteria and requires same-day paediatric assessment. A 999 response is not indicated because there is no apnoea, cyanosis, severe respiratory distress or seriously unwell appearance. Home management is therefore unsafe. Bronchiolitis is usually viral, and antibiotics are not indicated without evidence of bacterial infection. Salbutamol and systemic corticosteroids do not improve routine bronchiolitis outcomes and should not be used. The previous explanation incorrectly presented a saturation below 92% as a universal admission threshold; for infants aged at least 6 weeks, the secondary-care saturation threshold for admission is persistently below 90%, although inadequate intake is an independent admission criterion.

Reference: NICE guideline NG9. Bronchiolitis in children: diagnosis and management, recommendations 1.2.2, 1.3.2 and 1.4.3. Updated 2021. https://www.nice.org.uk/guidance/ng9/chapter/recommendations