Thread by @TessaRDavis

Bronchiolitis is everywhere.

Most of us find it pretty easy to identify infants with severe bronchiolitis.

What's harder is working out which infants with bronchiolitis are safe to send home, and which need to stay.

Here are my 5 top tips on managing bronchiolitis well: 🧵👇

Tip #1: Assess the feeding.

Most people know that we are aiming for >50% of normal feeds.

How do we make this assessment in breast fed babies?

We can ask about:

• length of feeding
• frequency of feeding
• how full the parent feels after a feed

All of these help us assess

Many babies with bronchiolitis will have shorter and more frequent feeds.

As long as they are getting around 50% of normal feeds in total that's fine.

A great tip is to ask about the frequency of wet nappies + how heavy they feel compared to normal.

Parents know this readily.

Tip #2: Know the high risk babies.

We need to be more cautious with this group.

This stops us sending home babies that are more likely to deteriorate:

• premature
• very young (<3m)
• chronic lung disease
• immunodeficiency
• neuromuscular discorder
• cardiac condition

Tip #3: The drugs don't work (except oxygen)

It's tempting to try SOMETHING, but....don't try the drugs below.

Resist:

❌ Salbutamol
❌ Nebulisers
❌ Drops
❌ Antibiotics
❌ Steroids
❌ Adrenaline

None of these are going to help or change the course of the illness.

But these 3 things CAN help.

Firstly, oxygen supplementation can help babies with low sats (around 92% depending on guidelines)

Secondly, high flow can help provide extra support for babies with severe work of breathing

Thirdly, some babies need help with feeds (NG or IV).

Tip #4: Know your discharge criteria

The easiest way to do this?

Ensure your patient:

• Isn't having apnoeas
• Feeds well
• Has wet nappies
• Has stable oxygen sats
• Has normal/mild respiratory effort

With all these in place you will be making a safe discharge.

Tip #5: Safety net well

Finally, this is the most underrated advice of all

There's no point sending a family home if they aren't comfortable, confident + know when to return.

We know that bronchiolitis may get worse before it gets better.

Make sure the parents know that too.

Make sure parents know what to look out for:

• Worsening work of breathing
• Feeding problems
• Lethargy
• Reduced wet nappies
• Apnoeas

They need to be able to return + feel happy to do so

It's also a good time to discuss smoking cessation.

Don’t avoid the conversation.

TL;DR - 5 top tips on managing bronchiolitis to ensure you discharge safely and appropriately.

• Tip #1: Assess the feeding
• Tip #2: Know the high risk babies
• Tip #3: The drugs don't work (mostly)
• Tip #4: Know your discharge criteria
• Tip #5: Safety net well

If you found this thread valuable:

1. Follow me for more threads on paediatrics and decision-making → @tessardavis

2. Here’s another similar thread you might enjoy:

3. Watch the full video here:

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