From: garfield@software.org (Donna Garfield)
Subject: Re: Bronchiolitis: Is Hospitalization Necessary?
Organization: Software Productivity Consortium, Herndon, Virginia
Date: Mon, 14 Dec 1992 15:32:32 GMT

In making the decision on whether or not to hospitalize a child with
bronchiolities, what should be the deciding factor is the degree of
respiratory distress (how much trouble breathing) the child is having, 
and how equipped the parents are to handling the situation at home...
(whether they have a nebulizer, medications, etc.)

Last fall my 1 1/2 year old also developed bronchiolitis, he started
wheezing Friday afternoon, and I started the Proventil nebulized treat-
ments followed by Chest PT and drainage (I was a pediatric nurse
prior to having my two children).  By that evening the treatments were
two hours apart and barely holding him...By 10:00 we were to every 1 1/2,
which I continued throughout the night. (Usually I refuse to do treatments
more frequently than every two hours, but I will do almost anything to 
avoid the ER on a Friday night, and I knew I could take him to the pedia-
tricians first thing in the am). I continued the treatments all night 
every 1 1/2 and carted him off to the pediatricians first thing....where I
was rewarded with : Yes, he has bronchiolitis, yes your doing wonderfully
with his treatments, continue every hour and a half and if he's not improving
by tomorrow call us....We need to save the hospital beds for children
that can't be handled at home...Oh if he starts getting cyanotic (turning
blue around the mouth, or nailbeds) bring him to the ER. I cried all the
way home...the mere thought of continuing the 1 1/2 treatments through the
weekend by myself was not what I needed.

By Sunday morning the treatments were back to 2 1/2 hours, and by Monday to
3 1/2 hours, so we survived. But I can honestly say I would not want to
do it again, and if they had suggested admitting him I would have agreed
in a heartbeat.

For those interested, I have included a short synopsis on bronchiolitis
from one of my old textbooks:

BRONCHIOLITIS:

Description: One of the more common infectious diseases of lower respiratory
tract, with maximal obstructive impact at the bronchiolar level; it consists
of hypersecretion, edema, and inflammatory reaction confined to smaller
bronchioles.

Age-group affected: Usually children between ages 2 and 12 months; number 3 
cause of death in children in this age-group. Rare after age 2 years. Peak 
incidence at approximately age 6 months of age. Increased incidence in children
born prematurely.

Etiologic agent: Viral; predominantly respiratory syncytial (RS) virus; also
adenoviruses, parainfluenza viruses, and Mycoplasma pneumoniae.

Manifestations: Begins as simple upper respiratory tract infection with 
serous nasal discharge. May be accompanied by moderate temperature elevation.
Gradually develops increasing respiratory distress, paroxysmal cough, dyspnea,
and irritability. Tachypnea with flaring nares and intercostal and subcostal
retractions. Emphysema with barrel chest and palpable liver and spleen from
depressed diaphragm. Shallow respiratory excursion. Fine rales and prolonged
expiratory phase; diminished breath sounds, hyperresonance, and scattered 
consolidation. May be wheezing.

Treatment: Rest. High-humidity atmosphere. Oxygen in moderate to severe cases. 
Adequate hydration.


                                       Donna
                                       garfield@software.org