University Hospital of Wales Paediatric Intensive Care Unit Guideline Printed on Wed 23-jul-08
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Last updated March 7, 2019 8:21 AM

0300 0300 789

02920 744622

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029 2184 7322


Noah's Ark Childrens Hospital for Wales
Heath Park
CF14 4XW
02920 747747


Indication for intubation is based on clinical features rather than blood gas results.


Differential diagnosis

Bronchiolitis is so common over the winter months it can be easy to forget that there are other diagnostic possibilities in infants presenting with respiratory failure.

Differential diagnosis includes immunodeficiency (FTT, diarrhoea, lymphopaenia), cystic fibrosis (FTT, diarrhoea), pertussis (marked lymphocytosis) and TAPVC (left sided heart failure) or other congenital heart disease (murmur, refractory hypoxia).

Remember to look for evidence of failure to thrive, history of diarrhoea and evidence of heart failure.

Antibiotics are only if indicated by positive cultures or sepsis syndrome. NPA and NBL for all ventilated patients - samples sent for bacteriology, virology NBL to look for Pneumocystis should be requested if there is a suspicion of immunodeficiency (e.g. lymphopaenia) If the presentation was with apnoea, and RSV bronchiolitis is not confirmed, an LP should be performed (in the absence of contraindications) Feed enterally as soon as possible

RSV prophylaxis

The neonatal unit has produced guidlines for the use of RSV prophylaxis in ex-premature infants.

Recommendations for use

In 2010 the Joint Committee on Vaccination and Immunisation (JCVI)(3) updated its recommendations on immunisation for RSV. 

The following summarises the patients concerned:

Full guideline here