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Bronchiolitis

Bronchiolitis is an acute wheezing_associated illness which occurs in early life, preceded by signs and symptoms of an upper respiratory infection. Infants may have a single episode of bronchiolitis or may have multiple occurrences in the first bronchiolitis.

Epidemiology

Bronchiolitis occurs most frequently from early November and continues.

Bronchiolitis is most serious in infants who are less than one year old, especially those 1_3 months old. Infants at risk include those who are raised in crowded living conditions, who are passively exposed to tobacco smoke, and who are not breast-fed.

Pathophysiology

Respiratory syncytial virus (RSV) is the leading cause of bronchiolitis in infants and young children, accounting for 50% of cases of bronchiolitis.

Infants born prematurely, or with bronchopulmonary dysplasia (BPD), immunodeficiency or congenital heart disease are at especially high risk.

RSV is transmitted by contact with nasal secretions. Shedding of virus occurs 1 to 2 days before symptoms occur, and for 1 to 2 weeks afterwards.

Treatment

Outpatient management of bronchiolitis is appropriate for infants with mild disease.

Criteria for hospitalization

History of prematurity (especially less than 34 weeks)

Congenital heart disease

Other underlying lung disease

Low initial oxygen saturation suggestive of respiratory failure (O₂ saturation <95%, with a toxic, distressed appearance)

Age #3 months

Dehydrated infant who is not feeding well

Unreliable parents

Before hospitalization, infants should receive an aerosolized beta_adrenergic agent. A few infants will respond to this therapy and avoid hospitalization. If the response is good, the infant can be sent home, and an oral albuterol continued.

Hospitalized infants should receive hydration and ambient oxygen to maintain an oxygen saturation $92_93% by pulse oximetry.

Treatment of bronchiolitis in the hospital

Racemic epinephrine by inhalation may be administered as a therapeutic trial. It should be continued if an improvement in the respiratory status is

Ribavirin

Ribavirin, an antiviral agent, produces modest improvement in clinical illness and oxygenation. Ribavirin is helpful in severely ill or

High-dose ribavirin is given for 2 hours, three times a day using an 

Treatment with ribavirin combined with RSV immune globulin administered either parenterally or by aerosol is more effective than therapy with either agent alone. Corticosteroid use in the treatment of bronchiolitis is

Prevention of RSV bronchiolitis with immunoglobulin prophylaxis

Prophylactically administered immunoglobulin with antibody to RSV ( RespiGam) has been shown to reduce the incidence of severe disease and hospitalization in high-risk children. The decision to use RSV-IGIV should be