1 Bronchiolitis has resurged since COVID-19-related physical distancing measures have been relaxedBronchiolitis is a viral lower respiratory tract infection, leading to small airway inflammation and edema, and is usually caused by respiratory syncytial virus. Before the COVID-19 pandemic, in Ontario, 2.6/100 children younger than 1 year had a visit to an emergency department for bronchiolitis. Incidence decreased during 2020 owing to masking, school closures and physical distancing measures. However, when those were relaxed, many countries experienced off-seasonal resurgence and more presentations of children older than 1 year. 2 Infants typically present with symptoms of viral respiratory infection; neonates may present with apneas or cyanosis only Most children present with low-grade fever, tachypnea, chest wall retractions and reduced oral intake, with crackles and wheeze bilaterally. Risk factors for severe bronchiolitis include cardiorespiratory, neuromuscular or immunodeficiency comorbidities; age 3 months or younger; and prematurity. Bacterial pneumonia should be considered if fever is 39°C or higher or there are unilateral chest signs on auscultation. 3 Investigations are not recommended routinely Nasopharyngeal swabs do not alter management but may be used to cohort children in hospital.1 Chest radiographs and blood tests are not indicated unless the presentation is severe (i.e., requiring intensive care) or the diagnosis is unclear. Children should be referred for possible admission if there is moderate increased work in breathing, coughing with sustained vomiting, signs of dehydration, or oxygen saturations less than 90% in room air.
Peter J. Gill、Neil Chanchlani、Sanjay Mahant
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Institute of Health Policy, Management and Evaluation
NSTL
Cma-Canadian Medical Assoc
