A three-week-old premature baby was brought in to the pediatric emergency ward of a Bengaluru hospital recently. Parents reported that the baby was not feeding properly, appeared to be holding its breath sometimes and the baby’s hands and legs were appearing bluish. A nasal swab test confirmed that the baby was suffering from bronchiolitis, a common respiratory tract infection, caused in this case, by the Respiratory syncytial virus (RSV).
Dr Sameera S Rao, consultant pediatrician and neonatologist, Motherhood Hospitals, Banashankari, Bengaluru, who treated the baby says that bronchiolitis is one of the most seen respiratory infections in children below the age of two years. “Almost 90 % of all children will have bronchiolitis at some point before their second birthday. Over 70% of the kids present with cold, cough and, fever etc which will last between five and seven days and is easy to recover from,” says Dr Rao.
What is bronchiolitis?
Bronchiolitis infections are most common before the beginning of winter or during monsoon season in India, says Dr Himanshu Batra, consultant-pediatrics, HCMCT Manipal Hospital, Dwarka, New Delhi.
“Our breathing tubes start from the nose, after this comes the trachea and bronchus and then come the small airways which we call the bronchioles. They are part of the breathing tubes which go into your lungs. Bronchiolitis is hence an inflammation in those small airways or bronchioles,” says Dr Batra.
What causes bronchiolitis?
Dr Batra says that bronchiolitis, a lower respiratory tract infection, can be caused by a number of viruses- including the RSV, the Parainfluenza virus etc.
“These viruses are commonly known to cause an inflammation in these airways. These airways are already narrow and an inflammation further makes them narrower. This means that the child may develop breathing difficulties very quickly,” says Dr Batra.
Bronchiolitis in infants
Dr Batra says that while bronchiolitis is a common infection among people of all age groups, it affects children more severely than it affects adults.
“Some adults may already have developed an immunity against this virus and secondly, their airways are much larger in diameter. So, even if a slight narrowing does occur, it does not affect them that much,” says Dr Batra.
RSV/ bronchiolitis symptoms
Dr Batra says that while bronchiolitis may begin as a mild cold, it can quickly progress to breathing difficulties in 2-3 days.
“As the virus enters an infant’s body through the nose, the infection begins, but only as a mild cold. It can quickly progress to breathing difficulties in a couple of days as the infection reaches the chest,” says Dr Batra.
“When babies experience breathing difficulties, they also struggle to feed properly. They become very dull and lethargic and this is when most parents get very worried,” adds Dr Gurudutt A V, head of Pediatric Intensive Care Unit, Manipal Hospital, Varthur Road and Rangadore Memorial Hospital.
Dr Batra says that since infants will not be able to express that they’re facing breathing difficulties, there are some related warning signs that parents can watch out for.
“If parents observe that their infant who had only a mild cold to begin with is quickly starting to breathe very rapidly, it could be an indication that the child is suffering from bronchiolitis,” says Dr Batra.
Dr Gurudutt says that bronchiolitis tends to be more severe in premature and low birth-weight babies, babies with congenital heart conditions, and babies with low immunity
Bronchiolitis v/s common cold
Bronchiolitis, as the name itself suggests, is an infection involving the bronchioles or the airways or breathing tubes present lower down in our lungs, says Dr Gurudutt, adding “A common cold, meanwhile, is just something that involves the nose- it mostly is limited to nasal symptoms and does not involve the lungs. This is why children with common cold, they often tend to have just a blocked nose whereas children with bronchiolitis may have a blocked nose and also a difficulty in breathing.”
Bronchiolitis treatment
Dr Gurudutt says that while bronchiolitis can become severe in some cases, there are a large number of babies whose illness can be managed in the ward or on an outpatient basis.
“One of the basic principles of treating bronchiolitis is ensuring that the child is adequately hydrated. Sometimes, the child would also require medicines through nebulization, which can help to an extent. Some simple devices like the high-flow nasal cannula can help keep the airways open through the nose. Some medications can also help treat the swelling and inflammation,” says Dr Batra.
Dr Gurudutt says that while antibiotic medications can help treat bacterial infections, in case of viral infections like bronchiolitis, one must “simply let the infection run its course while providing supportive care.”
Prevention
Dr Batra says the RSV vaccine can reduce the risk of bronchiolitis. “This vaccine is unfortunately not available in India yet. Influenza and flu shots can hence help to an extent,” he says, adding that breastfeeding in the initial months can help boost the baby’s immunity.
Dr Rao says passive smoking, visiting crowded places, having an older sibling who attends school etc are all risk factors for bronchiolitis. “Preventive measures such as washing your hands with soap and water regularly, avoiding contact with people who are ill and proper cough etiquette may help.”
Takeaways
- Bronchiolitis, a lower respiratory tract infection common among children in the 0-2 years age group, can cause mild fever and respiratory symptoms which can quickly progress to breathing difficulties.
- Infants not feeding properly, crying and appearing irritable, and showing signs of abdominal retractions are all warning signs that parents must watch out for.
