Patient will present as → a 5-month old infant with a three-day history of a mild respiratory tract infection with serous nasal discharge, fever of 38.5 C, and decreased appetite. Physical exam reveals a tachypneic infant with audible wheezing and a respiratory rate of 65. Nasal flaring, use of accessory muscles, subcostal and intercostal retractions are noted. Expiratory wheezes and a cough are present.
RSV is the most common cause of lower respiratory tract infections in children worldwide. Virtually all children contract it by the age of three.
- It's the leading cause of pneumonia and bronchiolitis in infants. It may play a major role in the pathogenesis of asthma bronchiolitis
Distinct symptoms of RSV bronchiolitis include:
- Wheezing and coughing can persist for several months
- Low-grade fever
- Nasal flaring and retractions
- Nail Bed cyanosis
Nasopharyngeal secretions RSV antigen test
- CXR can show diffuse infiltrates
Indications for hospitalization include moderate tachypnea with feeding difficulties, visible retractions, and oxygen desaturation
- Supportive measures include albuterol via nebulizer, antipyretics and humidified oxygen
- Steroids (controversial)
- Symptoms resolve within five to seven days
Antibiotics are utilized to treat bacterial, not viral, illnesses.
Inhaled glucocorticoids (budesonide, fluticasone, dexamethasone) have not been beneficial in reducing symptom duration or readmission rates
Racemic epinephrine is not indicated in the treatment of bronchiolitis.
pulse oximetry of 94% on room air
A pulse oximetry reading of 94% on room air is equivalent to a PaO2 of approximately 80 mm Hg which indicates the child is not in severe respiratory distress.
children between 4-6 months of age
Children less than 2 months of age require hospitalization.
moderate tachypnea with feeding difficulties
hyperinflation and interstitial infiltrates on chest x-ray
Hyperinflation and interstitial infiltrates on chest x-ray are frequently seen with acute bronchiolitis and by themselves are not an indication for hospitalization.
Corticosteroids are not indicated for the treatment of previously healthy infants with bronchiolitis.
Antibiotics are not indicated in the treatment of bronchiolitis unless there is a secondary bacterial infection.
Palivizumab is used only for prevention of RSV infection.