When should I consider referring an infant with bronchiolitis to secondary care?

Consider referring an infant with bronchiolitis to secondary care if they have any of the following: apnoea (observed or reported), baby or child looks seriously unwell to a healthcare professional, severe respiratory distress, for example grunting, marked chest recession, or a respiratory rate of over 70 breaths/minute, or central cyanosis ¹.

Additionally, refer if the infant has a respiratory rate of over 60 breaths/minute, difficulty with breastfeeding or inadequate oral fluid intake (50% to 75% of usual volume), clinical dehydration, or persistent oxygen saturation of less than 92% when breathing air ¹.

Take into account known risk factors for severe bronchiolitis such as chronic lung disease, significant congenital heart disease, age under 3 months, prematurity (particularly under 32 weeks), neuromuscular disorders, or immunodeficiency ¹.

Consider social circumstances, the carer's skill and confidence, and distance to healthcare in decision-making for secondary care referral ¹.