Treatment regimen for acute bronchiolitis in children

The article was professionally consulted with Master, Doctor Truong Thanh Tam - Pediatrician - Department of Pediatrics - Neonatology - Vinmec Danang International General Hospital.

Acute bronchiolitis is common in children under 2 years of age, especially very young children who are still breastfed. The disease has many different levels, it can be mild, transient, the child will recover after a few days or it can be very severe, causing respiratory failure, death.

Acute bronchiolitis is an acute infection of the bronchioles less than 2mm in diameter, also known as bronchioles. The disease usually occurs in children under 2 years of age, especially children who are still breastfed (3-6 months). The typical symptoms of children with acute bronchiolitis are coughing, rapid breathing, and wheezing.
Causes of acute bronchiolitis in children are viruses such as respiratory syncytial virus (30-50% of cases), influenza and parainfluenza viruses (25%), adenovirus (10%). Pathogens attack the epithelial lining of the bronchi causing inflammation, edema, increased secretions, and increased mucus, especially in the bronchioles. If the bronchial area is severely damaged, it can cause spasm and obstruction in the bronchioles, causing atelectasis, alveolar gas retention.
Acute bronchiolitis in children often occurs in winter when the weather is wet, the disease has many levels, can be mild transient but can also be very severe, causing respiratory failure leading to death. Severe acute bronchiolitis usually occurs in children with risk factors such as:
Premature babies under 36 weeks, birth weight < 2500g, newborn respiratory failure Children under 3 months of age Children with medical conditions such as: congenital heart disease, congenital lung disease (pulmonary cystic fibrosis, bronchopulmonary dysplasia,...). Neurological and neuromuscular diseases Children with immunodeficiency, severe malnutrition

The doctor diagnoses acute bronchiolitis based on:
Asking history: The child has a mild fever, stuffy nose, runny nose, wheezing, cough, and little feeding in the first few days. Then increased wheezing, irritability, fussiness, poor feeding in the following days. The environment the child lives in is a smoker or a home with a sick child. Children with risk factors for severe bronchiolitis. On clinical examination, the child has the following signs:
Children wheezing, exhaling for a long time, rising and falling of the nostrils, signs of chest indentation, groaning, cyanosis. Pulmonary rales: When listening to the lungs, there are snoring rales, rales or rales may not be heard due to complete obstruction of the lung. Apnea 15-20 seconds: Common in infants, premature babies, or babies under 2 months of age. Distinguishing acute bronchiolitis from other diseases such as pneumonia, asthma, foreign body in the airway, whooping cough, heart failure, gastroesophageal reflux, ...

Laboratory techniques that can be used to diagnose and determine the extent of the disease are:
Complete blood count, CRP, Chest X-ray, Arterial blood gas, Test for pathogens Disease: rapid PCR test for respiratory syncytial virus, Adenovirus from oropharyngeal specimens Children have severe acute bronchiolitis when one of the following factors is present:
Cyanosis Moaning Quitting sucking: Amount of milk consumed consumption is reduced by more than half of normal Irritability, restlessness, lethargy, impaired consciousness Rapid breathing >70 breaths/minute SpO2 <95% with air The child is breathing irregularly, has pauses in breathing Child has signs accessory muscles of respiration such as intercostal contraction, sternal concavity, severe chest constriction, nasal aspiration

3.1. Principles of treatment of acute bronchiolitis in children Focus on treating symptoms, providing enough water, oxygen, and electrolytes for children. Use antibiotics when the child has a bacterial superinfection. Combined treatment of comorbidities.
3.2. Specific treatment 3.2.1. Outpatient treatment:
If the disease is mild, after examination, the doctor will prescribe medicine and guide parents on how to take care of the child at home:
Give the child fever-reducing medicine Paracetamol when the child has a fever, dose and dose. Use 10-15mg/kg, two doses 4-6 hours apart. Use safe cough suppressants, usually herbal cough medicines, in syrup form suitable for children, do not use cough suppressants dextromethorphan, antihistamines, vasoconstrictors, expectorants, opiates, etc. prescribe bronchodilators, corticosteroids, do not prescribe antibiotics. Clean the nose regularly with physiological saline to help the child clear the airway. Feed the child, breastfeed normally, divide milk and food into many small meals, give the child plenty of water to drink. Re-examination after 1-2 days, however, if there are signs of serious illness, parents must take the child to the doctor immediately.

3.2.2. Inpatient treatment
When the child has severe acute bronchiolitis, the child needs to be hospitalized for treatment. Treatment for children includes:
3.2.2.1. Supportive treatment
Respiratory support:
Have the child lie down with his head elevated, regularly suction sputum to help open the airway. Indications for oxygen, non-invasive mechanical ventilation, invasive mechanical ventilation, CPAP according to each case. Using bronchodilators: Salbutamol nebulized 1-2 times 20 minutes apart, dose 0.15mg/kg/time, minimum 2.5mg/time, maximum 5mg/time. Assess the child's response after 1 hour, if respond, continue taking the drug after 4-6 hours, if not, stop the drug. Use 3% saline for first-time wheezing unresponsive to bronchodilators. Provide enough nutrition, water, electrolytes:
Divide milk and baby food into many small meals, reduce the amount of milk per feeding but increase the number of feedings to ensure nutrition for the baby. Careful breastfeeding is required if the infant is breathing rapidly >60 breaths/minute because of the high risk of aspiration. If the baby is nursing, eating too little, or not having enough energy to meet the needs, the doctor may prescribe a nasogastric tube, slow milk gavage, or partial parenteral nutrition. Feeding through a nasogastric tube is indicated in the following cases: children vomiting continuously after eating; rapid breathing 70-80 times/minute; when the child eats/breastfeeds SpO2 falls below 90% even with oxygen; poor coordination of sucking-swallowing-respiratory movements, markedly increased respiratory work when eating, drinking and sucking. Parenteral feeding is required when the child is dehydrated, has severe respiratory failure, or is inadequately fed parenteral nutrition (<80ml/kg/day).

3.2.2.2. Treatment of complications
Use antibiotics when the child shows signs of infection such as: sudden, prolonged high fever, rapid deterioration in clinical symptoms within 24-48 hours, blood count test results white blood cell count increased, polymorphonuclear leukocyte predominates, CRP >20mg/l, X-ray image showed pulmonary coagulation infiltrates, sputum culture (+), blood culture (+). Select antibiotics for initial use as in the treatment of bacterial pneumonia. The duration of antibiotic treatment is 7-10 days.
3.2.2.3. Monitoring during treatment
Children need to be closely monitored during treatment, urinary signs such as body temperature, pulse, breathing rate, cyanosis, SpO2 are monitored every 1-2 hours in 6 first hour. If the child's condition improves, monitor every 4-6 hours. Monitor for early detection of respiratory failure complications and signs of superinfection.

To limit the risk of acute bronchiolitis in children, the living environment around the child should be kept cool and clean. If there is a smoker in the family, it is advised to quit smoking or smoke away from the place where children live. Do not allow children to come near or have direct contact with people who have respiratory illnesses.
Need to wash hands before taking care of children. Provide children with adequate nutrition, breast milk for the first 6 months. Get your child vaccinated on schedule.
As a key area of ​​Vinmec Health system, Pediatrics Department always brings satisfaction to customers and is highly appreciated by industry experts with:
Gathering a team of top doctors and nurses in Pediatrics : consists of leading experts with high professional qualifications (professors, associate professors, doctorates, masters), experienced, worked at major hospitals such as Bach Mai, 108.. Doctors All doctors are well-trained, professional, conscientious, knowledgeable about young psychology. In addition to domestic pediatric specialists, the Department of Pediatrics also has the participation of foreign experts (Japan, Singapore, Australia, USA) who are always pioneers in applying the latest and most effective treatment regimens. . Comprehensive services: In the field of Pediatrics, Vinmec provides a series of continuous medical examination and treatment services from Newborn to Pediatric and Vaccine,... according to international standards to help parents take care of their baby's health from birth to childhood. from birth to adulthood Specialized techniques: Vinmec has successfully deployed many specialized techniques to make the treatment of difficult diseases in Pediatrics more effective: neurosurgery - skull surgery, stem cell transplantation. blood in cancer treatment. Professional care: In addition to understanding children's psychology, Vinmec also pays special attention to the children's play space, helping them to have fun and get used to the hospital's environment, cooperate in treatment, improve the efficiency of medical treatment.

Recommended video:


Signs, how to care for children with upper respiratory infections at home