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Emergency referrals for children with RSV bronchiolitis

message from the paediatrician Alrijne

We are currently seeing a sharp increase in the number of emergency referrals of children with RSV bronchiolitis in the region. The supply is now frequently higher than the absorption capacity. The capacity of the A&E is also regularly under pressure.

We have consulted with the paediatricians in the region to distribute the burden on both wards and emergency care as well as possible between the LUMC and the Alrijne. 

If assessment of children in service is desired, children at the HAP in Leiderdorp are preferably seen in the Alrijne and children at the HAP in Voorhout in the LUMC. However, it is possible that after consultation with the paediatrician on duty at the Alrijne, an assessment will take place at the ERH at the LUMC. If admission is necessary, a bed will be taken where a bed is available. If patients are known in one of these (or other regional) hospitals, we ask them to consult with them primarily.

In children who are sent for assessment in case of suspected RSV, the treatment in the home situation may still be optimized

We are happy to think along with you to optimize the treatment at home. 

Here are a few more tips: 
Young infants: 

  • In case of feeding problems, offer smaller quantities but increase the number of feedings (sometimes a 3 hours) 
  • Rhinitis: frequent nasal dripping with saline solution, at least before each feeding. 
  • Low-threshold xylometazoline 0.025 % 4 dd 2 gtt bdz in the nose. 
  • In case of fever and discomfort: low-threshold paracetamol                      

Older children: 

  • In case of BLWI with brochos obstruction, puff for 3 hours with 200-400 mcg of salbutamol per spacer  
  • Rhinitis: frequent nasal dripping with saline solution,  
  • Low-threshold xylometazoline 0.5%, 4 dd 2 gtt bdz in the nose (from 2 years) 
  • In case of fever and discomfort: low-threshold paracetamol 

For dosages of medication see pediatric formulary 

See also: https://richtlijnen.nhg.org/standaarden/acuut-hoesten#volledige-tekst-richtlijnen-bronchiolitis 

With regard to the RS virus, it has been modelled on the NHG guideline for attachment, click HERE with some guides. Make use of this especially during triage!

The paediatricians really like it when the GP can consult with the paediatrician in an accessible way so that they can quickly remove unjustified concerns and use the ER capacity and admission capacity as usefully as possible. So if in doubt by the GP, please call the paediatrician on duty first. Asking specifically for the paediatrician via the telephone exchange

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