Author: Fiona Mendes / Editor: Yasmin Sultan / Reviewer: Fiona Mendes / Codes: / Published: 28/03/2022
A 12-week-old female infant attends your paediatric emergency department accompanied by her worried parents, who report that for the past three days she has had a runny snotty nose, dry cough and reduced feeding with episodes of vomiting milk after prolonged coughing soon after being fed milk. Parents say she is having wet nappies, but with reduced volume than usual.
She was previously well. Two days before the onset of her symptoms, she was visited by her 4-year-old cousin who had coryzal symptoms but was otherwise well.
The patient was born on time, without any complications during pregnancy or birth. Her immunisations are up-to-date.
On examination, this baby appears miserable. Skin is pink and well perfused. She has moist mucous membranes and is not clinically dry. She has nasal flaring and chest wall recessions, with scattered wheeze on auscultation. There is equal air entry bilaterally. Abdomen is soft and non-tender. She is moving all 4 limbs equally. No rashes seen.
Observations: Oxygen saturations 95% on room air, Respiratory rate 52 breaths per minute, HR 164 beats per minute, Capillary refill 2 seconds, temperature 37.4 degrees Celcius.
Based on your clerking and clinical assessment, you suspect that this baby has acute bronchiolitis.