Management

• Determine the need for immediate respiratory support.

  • Hypoxemia: oxygen therapy via nasal cannula

  • Refractory hypoxemia, signs of respiratory distress, respiratory failure: intubation, CPAP, or high-flow nasal cannula

• Start supportive measures including adequate hydration, relief of nasal congestion and/or obstruction, and monitoring.

• Unwell appearance, lethargy

• Moderate to severe signs of respiratory distress (including significantly elevated respiratory rate for age)

• Ongoing respiratory support required

• Need for supplemental hydration

• History of apnea

• Consider if:

  • Risk factors for severe bronchiolitis are present

  • Supportive care at home is not feasible

Respiratory support

• Frequently monitor routine vital signs including O2 saturation

• Adjust short-term oxygen therapy as needed.

• Provide regular external nasal suction. [1]

Caloric and fluid support

• Ensure patients receive the recommended daily intake for their age.

• Encourage normal oral feeds (e.g., with breastmilk, formula, regular diet for age) as tolerated.#

Respiratory distress increases caloric and fluid requirements but also increases the risk for aspiration during oral feeds. Nutritional and fluid support via a feeding tube (orogastric or nasogastric) and/or intravenously is often necessary.