Overview
Definition
An acute viral infection of the lower respiratory tract in infants, characterized by inflammation, mucus production, and bronchospasm in the bronchioles.
Epidemiology
The leading cause of hospitalization in infants under 1 year. Peak incidence in winter.
Etiology & Risk Factors
- Respiratory Syncytial Virus (RSV, in >70-80% of cases)
- Rhinovirus, Metapneumovirus, Adenovirus
Clinical Symptoms
- Starts with URI symptoms: Nasal congestion, rhinorrhea, mild cough
- Progresses in 2-3 days to: Tachypnea, wheezing, fine inspiratory crackles, nasal flaring, grunting, retractions
- Difficulty feeding and dehydration due to tachypnea
Clinical Approach
Diagnosis
- Clinical diagnosis based on age (<2 years) and exam findings
- Viral PCR nasal swab to confirm RSV (optional)
- Chest X-Ray showing hyperinflation and patchy atelectasis (not routinely recommended)
Management
- Supportive care: Frequent nasal suctioning (critical before feeds), hydration (IV fluids if respiratory rate >60), supplemental oxygen (keep Sat >90-92%)
- *Note: Bronchodilators (Albuterol), epinephrine, corticosteroids, and antibiotics are NOT routinely recommended*
- Palivizumab (monoclonal antibody) prophylaxis for high-risk preemies/cardiac infants
Complications
- Dehydration
- Apnea (especially in infants <2 months or preemies)
- Respiratory failure
- Atelectasis