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BRONCHIOLITIS AND
BRONCHOPNEUMONIA IN
PEDIATRICS
Atikah Ayu Miranda
030.15.035
A. Bronchiolitis
B. Bronchopneumonia
Clinical Manifestation
A. Bronchiolitis
■ The initial symptoms that may arise are signs of acute respiratory infection in the
form of fever, cough, runny nose and sneezing.
■ One to two days later a cough arises accompanied by shortness of breath
■ Next can be found wheezing, cyanosis, grunting, vomiting after coughing, fussing
and decreased appetite
■ Nasal flaring and intercostal, supracostal and subcostal retractions
B. Bronchopneumonia
■ Symptoms and signs of pneumonia can be distinguished into common (non-specific)
symptoms, pulmonary, pleural or extrapulmonary symptoms.
■ Non-specific symptoms include fever, chills, cephalgia, restlessness and anxiety
■ Some patients may experience gastrointestinal disorders such as vomiting, bloating,
diarrhea or abdominal pain
■ After initial symptoms such as fever and cold cough, symptoms of nasal flaring,
tachypnea, dyspnea and apnea arise
■ Chest indrawing
Diagnosis
■ A. Bronchopneumonia
WHO recommends the use of
increased breathing frequency and
subcostal retraction to classify
pneumonia in developing countries :
■ Brochiolitis
The diagnosis in most cases of bronchiolitis is clinically evident and does not require
diagnostic testing.
• Patients usually report a history of recent upper respiratory tract symptoms such as
rhinnorhea
• Lower respiratory tract symptoms such as cough, tachypnea, and increased work of
breathing follow the upper respiratory prodrome.
• Wheezing during expiratory, expiratory extends, hipersonor when percussion.
Hyperinflated chest, crackles, wheeze on auscultation
Treatment
A. Bronchopneumonia
Criteria for hospitalization :
1. Mild pneumonia
■ Outpatient
■ First line antibiotics orally, for example amoxicillin 25 mg/KgBB/times given 2 times
a day for 3 days or cotrimoxazole 4 mg TMP/KgBB/times given 2 times a day for 3
days
2. Severe pneumonia
■ Oxygen to maintan saturation >92%, monitored every 4 hours, including
examination of oxygen saturation
■ If oral intake is lacking, intravenous fluids can be given and strict fluid balances are
carried out to prevent excessive hydration
■ In children with severe respiratory distress, oral feeding should be avoided
■ If the temperature of ≥ 390 C can be given paracetamol
■ Administration of antibiotic:
- Amoxicillin 25-50 mg/KgBB IV or IM every 6 hours, closely monitored within the first
72 hours. If the child respons well then it is given 5 days. Furthermore, therapy is
continued with oral amoxillin 15 mg/KgBB/times 3 times a day for the next 5 days
- If the clinical condition worsens before 48 hours or there is a severe condition suc
as unable to breastfeed or drink/eat or vomit everything, convulsions, letargis or
unconsciousness, cyanosis, severe respiratory distress then chloramphenicol 25
mg/KgBB/times IM or IV is added every 8 hours
- Second line antibiotics : Ceftriaxone 80-100 mg/KgBB IM or IV once a day
■ Return criteria
- Symptoms and signs of pneumonia disappear
- Adequate oral intake
- Giving antibiotics can be continued at home (orally)
- The family understands and agrees to provide therapy and control plans
- Home conditions allow for continued care at home
B. Bronchiolitis
RSV virus infections are usually self limiting, so treatment is usually only supportive
1. Oxygenation
Oxygen is given to all children by wheezing and severe respiratory distress, the
recommended method is with a nasal prongs, nasal catheter or nasopharyngeal
catheter with oxygen levels 30-40%.
2. Liquid
Giving fluids is very important to correct metabolic and respiratory acidosis that
may arise and prevent dehydration due to discharge through the mechanism of
evaporation due to rapid breathing patterns and difficulty drinking. If dehydration
doesn’t occur, maintenance fluids can be given either intravenously or nasogastricly
3. Bronchodilators and corticosteroids
Albuterol and epinephrine and systemic cortosteroids should not be given.
Hypertonic saline nebulisation can be given to treated children. Nebulisation is useful to
increase the work of the mucociliary airway to clear mucus and cellular debris found in
the respiratory tract.
4. Antivirus
The American Academy of Pediatrics recommends the use of ribavirin in
conditions that are expected to become more severe, such as those with bronchiolitis
with cardiac abnormalities, cystic fibrosis, chronic pulmonary disease,
immunodeficiency, and in premature babies.
5. Antibiotics
Anti-bacterial is not necessary because most cases are caused by viruses,
unless additional infection is suspected.
6. Physiotherapy
Chest physiotherapy in bronchiolitis children with vibrational or percussion
techniques (5 trials) or passive breathing techniques is no better than reducing the
duration of oxygen therapy.
The differences between bronchiolitis and bronchopneumonia in
pediatric
Bronchiolitis Bronchopneumonia
History : History
- Early symptoms of acute respiratory infection due to - Preceded with acute respiratory infection for several
viruses days
- Then cough arises accompanied by shortness of - Fever (39-400 C), often seizures
breath - Dyspnea, rapid breathing, nasal flaring and cyanosis
- Wheezing, whimpering, breathing sounds, vomiting around the nose and mouth
after coughing, fussing and decreased appetite - Initially dry cough then becomes productive
- There is a history of contact with people with acute
respiratory infection
A. Bronchiolitis
Mostly the children with bronchiolitis recover uneventfully but several studies have
noted an increased risk of bronchial asthma in children who initially suffer from
bronchiolitis.
B. Bronchopneumonia
With appropriate and adequate administration of antibiotics, mortality can be reduced
to less than 1%.
Conclusion
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