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Bronchiolitis — MRCEM SBA MCQ

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EasyPaediatric emergenciesBronchiolitisMRCEM SBA

A 10-week-old infant is assessed in the emergency department after three days of coryza followed by cough and increased work of breathing. He has widespread fine crackles and mild subcostal recession but is alert, with a respiratory rate of 52 breaths/minute and normal perfusion. He has taken approximately 55% of his usual milk volume over the past 12 hours despite frequent small feeds. Using an appropriately fitted probe, his oxygen saturation remains 91% in air on repeated measurements. He was born at term, has no underlying health condition and has had no apnoea. What is the most appropriate management plan now?

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Correct answer: B — Admit for nasogastric fluids without supplemental oxygen

The coryzal prodrome, cough, crackles and increased work of breathing are consistent with bronchiolitis. His intake remains inadequate despite attempts at smaller feeds, so he needs admission and fluid support. NICE recommends nasogastric or orogastric fluids when a child with bronchiolitis cannot take enough by mouth. At 10 weeks, with no underlying health condition, his persistent saturation of 91% is above the threshold for supplemental oxygen, which is **less than 90%** for children aged 6 weeks and over. ([nice.org.uk](https://www.nice.org.uk/guidance/ng9/chapter/recommendations)) A overlooks the inadequate intake; discharge would become reasonable if feeding were adequate and he remained clinically stable. C provides appropriate fluid support but adds oxygen at a saturation that does not meet his age-specific threshold; it would be appropriate if his saturation fell persistently below 90%. D uses intravenous fluids prematurely: NICE reserves these for children who do not tolerate enteral fluids or have impending respiratory failure. E offers neither sufficient fluid support for his current intake nor an indicated oxygen treatment; supervised oral feeds with oxygen could suit an infant feeding adequately whose saturation met the oxygen threshold. ([nice.org.uk](https://www.nice.org.uk/guidance/ng9/chapter/Recommendations))

Reference: NICE NG9, Bronchiolitis in children: diagnosis and management — recommendations 1.3.2 and 1.4.4 (9 August 2021) — https://www.nice.org.uk/guidance/ng9/chapter/recommendations NICE NG9, Bronchiolitis in children: diagnosis and management — recommendations 1.4.11–1.4.12 (9 August 2021) — https://www.nice.org.uk/guidance/ng9/chapter/Recommendations