All That Wheezes…

[摘要] A 6-month-old previously healthy boy presented to the emergency department with a 2-day history of cough, wheeze, and increased work of breathing. The history and examination results were suggestive of bronchiolitis, and the patient was placed on a bronchiolitis protocol. He initially seemed to be responding to supportive care with nasal suctioning and supplemental oxygen only.Several days elapsed, and the tachypnea and hypoxia persisted. The infant was additionally noted to be a slow breastfeeder and he exhibited a marginal failure to thrive (weight at fifth percentile). On hospital day 6, he was still requiring 0.2 L nasal cannula oxygen to maintain saturations of 92% and persistently maintained a respiratory rate in the 50s. Chest radiography revealed mild hyperexpansion and peribronchial cuffing consistent with bronchiolitis, and the results of viral testing were negative.Does this case require patience or further testing? Risk factors for severe bronchiolitis are well established, including prematurity; age <2 months; chronic lung, heart, and neurologic diseases; poor nutritional status; and environmental tobacco smoke exposure.1–3 Even in otherwise healthy infants, complicating factors may prolong or alter the typical clinical course in bronchiolitis, including swallowing dysfunction, impaired nutrition, and development of superimposed infections.Small published series have demonstrated an increased risk of aspiration during the course of illness, reported in 60% of infants with bronchiolitis who underwent a videofluoroscopy swallow study. Thickening feeds demonstrated improvement in both aspiration and laryngeal penetration.4,5 A recent, retrospective study evaluated the associations of various clinical markers that could be attributed to any infant with bronchiolitis. Greater usage of supplemental oxygen, tachypnea, and decreased total caloric intake during …

[学科分类] 儿科学

[关键词] Campylobacter;proljev;dob