From the Guidelines
Bronchiolitis in a 2-month-old infant is typically characterized by symptoms such as rhinitis, cough, tachypnea, wheezing, and use of accessory muscles, and is most commonly caused by respiratory syncytial virus (RSV) 1.
Symptoms of Bronchiolitis
- Rhinitis and cough, which may progress to tachypnea, wheezing, rales, use of accessory muscles, and/or nasal flaring 1
- Acute inflammation, edema, and necrosis of epithelial cells lining small airways, and increased mucus production 1
- Tachypnea, defined as a respiratory rate ≥70 per minute, has been associated with increased risk of severe disease in some studies 1
Treatment Options
- Supportive care: The main goal of treatment is to support the infant's respiratory and hydration needs, as there is no specific treatment for bronchiolitis 1
- Oxygen therapy: May be necessary for infants with severe disease or hypoxemia 1
- Hydration: Ensuring adequate hydration is crucial, especially for infants who are at risk of dehydration due to increased respiratory rate and fever 1
- Palivizumab prophylaxis: May be considered for high-risk infants, such as those with congenital heart disease or chronic lung disease, to prevent RSV infection 1
Diagnostic Approach
- Clinical diagnosis: Bronchiolitis is a clinical diagnosis that does not require diagnostic testing, and can be made based on history and physical examination 1
- Radiographic or laboratory studies: Should not be obtained routinely, unless there are signs of a complication or an alternative diagnosis is suspected 1
From the Research
Symptoms of Bronchiolitis
- Bronchiolitis is a leading cause of acute illness and hospitalization for infants and young children worldwide 2
- It is usually a mild disease, but some children develop severe symptoms, including respiratory distress and dehydration 2, 3
- The severity of respiratory symptoms peaks between days 3-7 of the disease 4
- Dehydration is a key sign to consider for the management of bronchiolitis 4
Treatment Options for Bronchiolitis
- The mainstay of therapy for bronchiolitis is supportive care, including:
- High-flow nasal cannula has improved the delivery of oxygen 2
- Nebulized hypertonic saline enables better airway cleaning and has a benefit for respiratory function 2
- There is limited evidence to support the use of pharmacological therapies, including bronchodilators and corticosteroids 5, 6
- Nebulized adrenaline has demonstrated a short-term benefit in some studies 2
- Ribavirin is an antiviral drug that has been approved for the treatment of RSV infections, but its use is limited due to adverse side effects and risks to healthcare providers 3, 5