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Croup — RACP Paediatrics MCQ

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HardRespiratoryCroupRACP Paediatrics

A 4-month-old with bronchiolitis has persistent SpO₂ 86–88% and moderate work of breathing. After two hours of correctly delivered low-flow nasal oxygen, saturation remains below 90% and respiratory distress has not improved. Which escalation is most appropriate?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: B — Commence high-flow nasal-prong therapy and reassess respiratory response

Explanation lettering: E = shown as A · A = shown as B · B = shown as D · D = shown as E

A is correct. RCH reserves high-flow nasal-prong therapy for bronchiolitis with persistent saturation below 90% and no respiratory improvement after two hours of low-flow oxygen. B is not routine bronchiolitis treatment and should not delay respiratory support. C has no routine role in uncomplicated bronchiolitis. D reverses the indication: high-flow is unnecessary when saturation is consistently at least 90% and the child is improving. E may become necessary with exhaustion, apnoea or failure of non-invasive support, but it is not the immediate step in this still-supported infant. Hydration, minimal handling and serial assessment continue.

Reference: Royal Children’s Hospital Melbourne: Bronchiolitis: https://www.rch.org.au/clinicalguide/guideline_index/Bronchiolitis/