Living with premature bronchiolitis

Children with this illness will probably still have bronchiolitis symptoms when they leave hospital.

It is important to know that:

• Wheezing can last for up to 5 days.
• The cough and congested nose will slowly improve over 7-14 days.
• It may take up to a week for sleep and appetite to return to normal.

Care at home

• Using vaporisers is not recommended as their effectiveness has not been proven.

Children cannot drink or sleep easily with a congested nose. Saline nose drops can be used to dissolve mucus.  To do this correctly, you are advised to use a soft rubber suction bulb to remove mucus from each nostril. The process is repeated several times until the newborn can breathe easily through their nose, without making any noise.

Eating and drinking

It is very important for newborns to drink enough fluids. There are proven benefits of hydration with breast milk for respiratory syncytial virus infection. The child should be offered small amounts of food and drink, but more frequently than usual.

If the infant vomits due to coughing, wait a few minutes then try to feed them again.

Medication

Decongestant nose drops, antihistamines and all other cold medicines should not be administered to newborns unless indicated by a paediatrician.

Warning signs

The Spanish Society of Paediatric Pneumology considers that immediate medical attention should be sought if a newborn presents any of these symptoms.

Signs of breathing difficulties:

• Flaring nostrils or moving ribs when trying to breathe.
• Breathing more than 50-60 times per minute (when not crying).
• Grunting/moaning sounds when breathing.
• Sitting with hunched shoulders.
• Wheezing (whistling sounds when breathing) becomes more intense.
• The skin, nails, gums, lips or the area around the eyes are a bluish-purple or greyish colour (cyanotic).
• Being very tired.
• Being sleepier than usual.
• Becoming very fatigued when feeding, and eating very little.
• Frequent vomiting, inability to keep fluids down. The infant may be dehydrated due to lack of appetite or vomiting, especially if their nappies are drier than usual.

In addition to the warning signs mentioned above, there are other criteria for recommending hospital care. These are related to the newborn's previous medical history, the presence of respiratory distress, the existence of risk factors and the coexistence of clinical situations that may complicate the process.

Some of these criteria include:

• Being aged under 3 months.
• A history of prematurity (birth before the 35th week of pregnancy).
•  Underlying disease: congenital heart disease with haemodynamic repercussions, chronic lung disease (bronchopulmonary dysplasia, cystic fibrosis, congenital malformation, etc.), immunosuppression or chronic neuromuscular disease.
• A history of apnoea.
• Dehydration, vomiting. 
• Moderate bronchiolitis with no response to treatment.
• Severe bronchiolitis.

Prognosis

Breathing often improves by the third day, and the majority of symptoms disappear within a week. On rare occasions, pneumonia or more serious respiratory problems occur.

Some children may have problems with wheezing or asthma as they get older.