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Bronchiolitis — UKMLA MCQ

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ModeratePaediatricsBronchiolitisUKMLAMRCEM SBAMRCGP AKTPARA

A previously well 5-month-old infant is assessed in a paediatric emergency department with clinical bronchiolitis. Over the past 12 hours, the infant has taken 40% of their usual milk volume. Oxygen saturation on room air remains 90–91% on repeated appropriate measurements. There is moderate chest recession but no apnoea, cyanosis, exhaustion or focal chest signs. Which is the most appropriate management?

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Correct answer: C — Admit for enteral feeding support and clinical observation

The correct answer is C. Taking only 40% of the usual milk volume represents inadequate intake and warrants admission for observation and feeding support. If oral intake remains insufficient, nasogastric or orogastric fluids are preferred; intravenous isotonic fluids are reserved for intolerance of enteral fluids or impending respiratory failure. In an otherwise healthy infant aged over 6 weeks, supplemental oxygen is started when room-air SpO2 is persistently below 90%, so 90–91% requires monitoring rather than automatic oxygen treatment. Discharge is inappropriate because of the poor intake. Prednisolone and salbutamol do not improve routine bronchiolitis outcomes, and amoxicillin is not indicated without evidence of bacterial infection such as pneumonia.

Reference: NICE guideline NG9, Bronchiolitis in children: diagnosis and management, recommendations 1.3.2, 1.4.3, 1.4.4 and 1.4.11, updated 2021. https://www.nice.org.uk/guidance/ng9/chapter/Recommendations