referral criteria from primary care - bronchiolitis
Last edited 08/2021 and last reviewed 08/2021
- Immediately refer children with bronchiolitis for emergency hospital
care (usually by 999 ambulance) if they have any of the following:
- apnoea (observed or reported)
- child looks seriously unwell to a healthcare professional
- severe respiratory distress, for example grunting, marked chest recession, or
- a respiratory rate of over 70 breaths/minute
- central cyanosis
- consideration of referral for a child with bronchiolitis to hospital if
they have any of the following:
- a respiratory rate of over 60 breaths/minute
- difficulty with breastfeeding or inadequate oral fluid intake (50-75% of usual volume, taking account of risk factors and using clinical judgement)
- clinical dehydration
- persistent oxygen saturation of less than 92% when breathing air
Notes:
- when deciding whether to refer a child with bronchiolitis to secondary care,
take account of the following risk factors for more severe bronchiolitis:
- chronic lung disease (including bronchopulmonary dysplasia)
- haemodynamically significant congenital heart disease
- age in young infants (under 3 months)
- premature birth, particularly under 32 weeks
- neuromuscular disorders
- immunodeficiency
- When deciding whether to refer a child to secondary care, take into account
factors that might affect a carer's ability to look after a child with bronchiolitis,
for example:
- social circumstances
- the skill and confidence of the carer in looking after a child with bronchiolitis at home
- confidence in being able to spot red flag symptoms
- distance to healthcare in case of deterioration
Provide key safety information for parents to take away for reference for children who will be looked after at home. This should cover:
- how to recognise developing 'red flag' symptoms:
- worsening work of breathing (for example grunting, nasal flaring, marked chest recession)
- fluid intake is 50-75% of normal or
- no wet nappy for 12 hours
Reference: