What counsel should be given to a mother of a premature baby born at 29 weeks regarding bronchiolitis prevention?

Counseling for Bronchiolitis Prevention in a 29-Week Premature Infant

This infant born at 29 weeks gestation qualifies for palivizumab (Synagis) prophylaxis and should receive it, along with comprehensive education about preventing RSV transmission through hand hygiene, avoiding tobacco smoke, limiting crowd exposure, and recognizing that oral antibiotics have no role in viral bronchiolitis prevention. 1, 2, 3

Palivizumab Prophylaxis Indication

Your infant qualifies for RSV prophylaxis based on gestational age alone:

• Infants born at 29-32 weeks gestation should receive palivizumab prophylaxis up to 6 months of age during their first RSV season 1
• The infant does not need chronic lung disease or other risk factors to qualify—29 weeks gestational age is sufficient indication 2, 3
• Palivizumab reduces RSV hospitalization risk by approximately 45-55% in high-risk infants 2, 4

Administration Protocol

If the infant qualifies by age and timing, initiate prophylaxis immediately:

• Give 15 mg/kg intramuscularly every 28-30 days for 5 monthly doses throughout RSV season (typically November through March) 2, 3, 4
• The first dose should be administered before RSV season starts, or as soon as possible if the season has already begun 2, 4
• Continue all 5 doses even if the infant reaches 6 months of age during the season 1

Critical Prevention Counseling Points

Hand hygiene is the single most important preventive measure:

• Hands must be decontaminated before and after direct contact with the infant using alcohol-based rubs or antimicrobial soap 1, 2
• This is more important than any other single intervention for preventing RSV transmission 1

Environmental and exposure modifications:

• Complete avoidance of tobacco smoke exposure—this is a controllable risk factor that increases RSV hospitalization risk 1, 2
• Limit exposure to crowds and restrict group childcare attendance during RSV season 1, 2
• Keep the infant away from situations where exposure to infected individuals cannot be controlled 1

Breastfeeding and immunization:

• Encourage breastfeeding to decrease lower respiratory tract disease risk 1, 2
• Ensure influenza vaccination for the infant starting at 6 months and for all household contacts 1, 2

What NOT to Do—Common Pitfalls

Oral antibiotics have absolutely no role in bronchiolitis prevention or treatment:

• Antibacterial medications should only be used if there are specific indications of coexistent bacterial infection 1
• Bronchiolitis is viral (primarily RSV), and antibiotics do not prevent or treat viral infections 1

Palivizumab is prophylaxis only, not treatment:

• It prevents severe RSV disease but does not treat active infection 3, 4
• If the infant develops RSV infection despite prophylaxis, continue monthly doses throughout the season 4

Recognition of Severe Reactions

Educate the mother about signs requiring immediate medical attention:

• Severe allergic reactions to palivizumab can include: severe rash, hives, swelling of lips/tongue/face, difficulty breathing, bluish skin color, or unresponsiveness 4
• These reactions are rare but require immediate emergency care 4

Answer to Multiple Choice Question

The correct answer is C (palivizumab prophylaxis), combined with counseling about A (transmission prevention through hand hygiene). Oral antibiotics (B) are incorrect as they have no role in viral bronchiolitis prevention, and reassurance alone (D) is inadequate given this infant's clear indication for prophylaxis. 1, 2, 3