What counseling should be provided to a mother of a premature baby born at 29 weeks with no complications, regarding concerns about bronchiolitis?

Counseling for Bronchiolitis Prevention in a 29-Week Premature Infant

The correct answer is to counsel about palivizumab prophylaxis and preventive measures, particularly emphasizing hand hygiene and avoiding respiratory droplet exposure—not oral antibiotics, which have no role in bronchiolitis prevention or treatment. 1

Why This Baby Qualifies for Palivizumab Prophylaxis

• This 29-week premature infant qualifies for palivizumab prophylaxis based on gestational age alone, even without chronic lung disease or other complications 2, 3
• Infants born at 29 to 32 weeks gestation are at high risk for severe RSV disease during their first RSV season, which occurs during the first 12 months of life 2, 3
• Palivizumab should be administered as 5 monthly intramuscular injections at 15 mg/kg per dose, typically beginning in November or December and continuing throughout RSV season 1, 2, 3
• The first dose should be given before RSV season starts to provide protection when exposure risk is highest 2
• Palivizumab reduces RSV hospitalization risk by approximately 45-55% in high-risk infants 2

Critical Preventive Measures to Counsel

Hand Hygiene (Most Important)

• Hand decontamination is the single most important step in preventing RSV transmission 1
• Hands should be decontaminated before and after direct contact with the infant using alcohol-based rubs or antimicrobial soap 1, 2
• All family members and caregivers must practice rigorous hand hygiene 1

Respiratory Droplet Precautions

• RSV is spread through respiratory droplets from coughing and sneezing, making cough a source of transmission 4
• Limit exposure to crowds and group childcare during RSV season (November through March in most regions) 2
• Avoid contact with individuals who have respiratory infections 4

Environmental Modifications

• Completely avoid tobacco smoke exposure, as it is a controllable risk factor that significantly increases RSV hospitalization risk 1, 2
• Encourage continued breastfeeding to decrease the child's risk of lower respiratory tract disease 1, 2

What NOT to Recommend

Oral Antibiotics Have No Role

• Antibacterial medications should only be used in children with bronchiolitis who have specific indications of coexisting bacterial infection 1
• Secondary bacterial infection is rare in bronchiolitis, and antibiotics are seldom necessary 5
• Routine antibiotic use is not indicated for prevention or treatment of viral bronchiolitis 1

Other Ineffective Interventions

• Bronchodilators, corticosteroids, and chest physiotherapy should not be used routinely in bronchiolitis management 1
• These medications do not prevent bronchiolitis and have no role in prophylaxis 1, 5

Common Pitfalls to Avoid

• Do not provide false reassurance alone—this premature infant has specific risk factors requiring active prophylaxis 1, 2
• Do not prescribe antibiotics prophylactically, as this increases antimicrobial resistance without benefit 1
• Do not delay palivizumab administration—timing is critical for optimal protection 2, 3
• Ensure the family understands that even with palivizumab, hand hygiene and environmental precautions remain essential 1, 2