Pulmonology focuses on diagnosing and treating lung and airway conditions such as asthma, COPD, and pneumonia, as well as overall respiratory health.
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Supportive Care as the Cornerstone
The main treatment for bronchiolitis is supportive care. Since it is caused by a virus, antibiotics do not help unless there is a proven bacterial infection like an ear or lung infection. The goal is to help the baby breathe and stay hydrated while their body fights the virus. This means giving oxygen if needed, making sure the baby gets enough fluids, and keeping the nose clear. Most mild cases can be treated at home with advice on what to watch for, but more serious cases need hospital care. At Liv Hospital, we use treatments that are proven to work and avoid unnecessary medicines, focusing on what really helps the baby recover.
For infants with hypoxemia, supplemental oxygen is the first line of therapy. Oxygen is typically delivered via nasal cannula to maintain saturation above a safe threshold, usually 90 to 92 percent.
Mechanical Ventilation: In the most critical cases involving respiratory failure, severe apnea, or exhaustion, intubation and mechanical ventilation may be necessary to take over the work of breathing fully.
Ensuring adequate hydration is critical. Respiratory distress and fever increase insensible fluid loss, while nasal congestion hampers intake. For hospitalized infants who cannot feed safely by mouth due to the risk of aspiration (respiratory rate > 60-70 breaths/min), nutrition and fluids must be provided by other means.
Intravenous (IV) Fluids: If nasogastric feeding is not tolerated, abdominal distension is present, or respiratory distress is severe, intravenous fluids are administered. Isotonic fluids are typically used to maintain electrolyte balance. Careful monitoring of fluid input and output prevents fluid overload, which can worsen pulmonary edema and respiratory status in cases of inappropriate ADH secretion (SIADH).
Babies mostly breathe through their noses, so a blocked nose makes it much harder for them to breathe. That’s why suctioning the nose is an important part of their care.
Chest Physiotherapy: Chest physiotherapy, which involves percussion and vibration of the chest, is not recommended for routine bronchiolitis. Studies have shown that it does not reduce hospital stay or improve clinical scores and may cause distress to the infant, thereby increasing oxygen consumption. It may be considered only in infants with significant comorbidities, such as neuromuscular disease, who cannot clear secretions.
The use of medications in bronchiolitis has been a subject of extensive research and debate. Current guidelines generally recommend against the routine use of most drugs.
Treatment also involves anticipating and managing potential complications.
Doctors decide when a baby can go home based on how stable they are and whether the family can care for them safely. The main things they look for are:
Infection control within the hospital is paramount to prevent the spread of the virus to other vulnerable patients. Infants with bronchiolitis are placed on contact and droplet precautions. This involves healthcare providers using gowns, gloves, and masks. Patients are often cohorted, meaning infants with the same confirmed viral infection (e.g., RSV positive) are placed in the same room. Strict hand hygiene protocols are enforced for staff and visitors. These measures are essential to contain the outbreak within the healthcare facility and protect immunocompromised or surgical patients from acquiring the infection.
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Antibiotics kill bacteria, not viruses. Since bronchiolitis is caused by a virus (like a cold virus), antibiotics will not help cure the infection and can cause side effects or lead to antibiotic resistance.
The high-flow machine delivers warm, moist oxygen at a higher rate than usual. This helps wash out carbon dioxide, keeps the airways open, and reduces the work the baby has to do to breathe.
Over-the-counter cough and cold medicines are not recommended for young children (ages 4-6). They are not effective for bronchiolitis and can have dangerous side effects like rapid heart rate or sedation.
Suctioning clears the nasal passages of thick mucus. Since babies breathe primarily through their noses, clearing this blockage is vital for them to breathe more easily, eat properly, and sleep comfortably.
Your baby can go home when they can breathe comfortably without extra oxygen, are feeding well enough to stay hydrated by mouth, and you feel confident managing their care at home.
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