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Bronchiolitis — DCH MCQ

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ModerateCommon childhood illnessesBronchiolitisDCH

An 8-month-old boy, born at term and previously well, is brought to the GP in January after 2 days of coryza, cough and poor feeding. He has fine crackles, wheeze and mild chest recession. His respiratory rate is 54/minute and repeated oxygen saturation is 93% in air. He has taken about half his usual feeds and has had no wet nappy for 12 hours. What is the most appropriate management?

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Correct answer: D — Refer to hospital for paediatric assessment

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

A is correct. This is typical bronchiolitis, and the important disposition features are intake of about 50% of normal and no wet nappy for 12 hours, indicating inadequate intake and possible dehydration. NICE recommends considering hospital referral when intake is 50% to 75% of usual or there is clinical dehydration. His saturation of 93% does not itself meet the primary-care referral threshold of persistently below 92%, and his respiratory rate does not exceed 60/minute, but these do not override the feeding concern. Home care or delayed review is therefore inappropriate. Salbutamol is not recommended for bronchiolitis, and antibiotics such as amoxicillin are not indicated without evidence of bacterial infection.

Reference: NICE. Bronchiolitis in children: diagnosis and management (NG9), recommendations 1.2.2, 1.4.3 and 1.6.1. Published 2015; updated 2021. https://www.nice.org.uk/guidance/ng9/chapter/Recommendations