Hydration and Comfort Management in RSV Treatment for Children
Adequate hydration and comfort measures are essential components of RSV treatment in children as they directly impact morbidity, mortality, and quality of life by preventing dehydration and respiratory distress.
Importance of Hydration
- Clinicians should assess hydration and ability to take fluids orally as a strong priority in children with RSV 1
- Children who are unable to maintain fluid intake due to breathlessness, fatigue, or associated gastroenteritis need fluid therapy to prevent dehydration 1
- Where possible, additional fluid should be administered via the enteral route; when nasogastric tube feeds are necessary, the smallest tube should be passed through the smallest nostril to minimize effects on respiratory status 1
- Severely ill children may need intravenous fluids; if the child is receiving oxygen therapy, intravenous fluids should be given at 80% of basal levels to avoid complications of inappropriate ADH secretion 1
- Adequate hydration helps thin secretions, making them easier to clear from the respiratory tract 2
Oxygen and Respiratory Support
- Hypoxic infants and children with RSV may not appear cyanosed; agitation may be an indication of hypoxia 1
- Supplemental oxygen is indicated if SpO2 falls persistently below 90% in previously healthy infants 1
- Oxygen should be administered via nasal cannulae, head box, or face mask to maintain oxygen saturation above 90-92% 1
- Oxygen may be discontinued if SpO2 is at or above 90% and the infant is feeding well with minimal respiratory distress 1
Comfort Measures
- Antipyretics and analgesics can be used to keep the child comfortable and help with effective coughing 1
- Fever and pain management is important as discomfort can interfere with feeding and hydration 1
- Pleural pain may interfere with depth of breathing and impair the ability to cough effectively 1
- The American Thoracic Society recommends providing information to families about managing fever, preventing dehydration, and identifying signs of deterioration 2
Monitoring Requirements
- The level of monitoring depends on the child's condition 1
- Severely ill children need continuous monitoring of heart rate, respiratory rate, oxygen saturation, and neurological status 1
- All children on oxygen therapy should have four-hourly monitoring including oxygen saturation 1
- Serum electrolytes should be monitored in children receiving intravenous fluids 1
What to Avoid
- Chest physiotherapy is not beneficial in previously healthy children with RSV bronchiolitis and should not be used routinely 1, 2
- Corticosteroid medications should not be used routinely in the management of bronchiolitis 1
- Ribavirin should not be used routinely in children with bronchiolitis 1
- Over-the-counter cough and cold medications should not be used in children under 2 years due to lack of proven efficacy and potential for serious toxicity 2
Discharge Criteria
- Children can be safely discharged when they are:
- Clearly improving
- Physiologically stable
- Able to tolerate oral feeds
- Have a respiratory rate <40/min (<50/min in infants)
- Maintain oxygen saturation >92% on room air 1
Prevention Strategies
- Hand decontamination is the most important step in preventing nosocomial spread of RSV 1
- Alcohol-based rubs are preferred for hand decontamination; an alternative is hand-washing with antimicrobial soap 1
- Clinicians should educate personnel and family members on hand sanitation 1
- Infants should not be exposed to passive smoking, which increases the risk of having an RSV infection 1
- Breastfeeding is recommended to decrease a child's risk of having lower respiratory tract disease 1
When to Seek Medical Attention
- Parents should seek medical attention if the child exhibits:
- Respiratory rate >70 breaths/min in infants or >50 breaths/min in older children
- Difficulty breathing, grunting, or cyanosis
- Oxygen saturation <92% (if measured)
- Poor feeding or signs of dehydration
- Persistent high fever or worsening symptoms 2