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
- Symptoms resolve within five to seven days
Palivizumab (Synagis) prophylaxis
- Infants born at ≤28 weeks 6 days gestational age and <12 months at the start of RSV season
- Infants <12 months of age with chronic lung disease (CLD) of prematurity
- Infants ≤12 months of age with hemodynamically significant CHD
- Infants and children <24 months of age with CLD of prematurity necessitating medical therapy (eg, supplemental oxygen, bronchodilator, diuretic, or chronic steroid therapy) within 6 months prior to the beginning of RSV season
AAP also suggests that palivizumab prophylaxis may be considered in the following circumstances:
- Infants <12 months of age with congenital airway abnormality or neuromuscular disorder that decreases the ability to manage airway secretions
- Infants <12 months of age with cystic fibrosis with clinical evidence of CLD and/or nutritional compromise
- Children <24 months with cystic fibrosis with severe lung disease (previous hospitalization for pulmonary exacerbation in the first year of life or abnormalities on chest radiography or chest computed tomography that persist when stable) or weight for length less than the 10th percentile
- Infants and children <24 months who are profoundly immunocompromised
- Infants and children <24 months undergoing cardiac transplantation during RSV season
|RSV, or respiratory syncytial virus, is a viral infection that infects upper airway epithelial cells, leading to copious secretions, coughing, sneezing and wheezing in patients. It primarily affects infants and young children with peak incidence between 2 to 7 months of age. It affects more male than female infants; occurs less frequently in breast-fed infants; and has a peak incidence during winter and spring. Most cases of bronchiolitis are caused by RSV.|
Antibiotics are utilized to treat bacterial, not viral, illnesses.
The use of corticosteroids in children with bronchiolitis has not been studied and does not appear to be helpful.
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.