July 29, 2010

Most common pathogen causing lower airway disease in infants and toddlers 90,000 hospitalizations/year $700 million/year for children <1y

Human to Human December to March No long-term immunity Universal infection by 2y 40% lower airway disease

Rhinitis Tachypnea Wheezing Cough Crackles Accessory muscle use Nasal flaring

Acute inflammation Edema and necrosis of epithelial cells lining small airways Increased mucus production Bronchospasm

CXR Peribronchial thickening or interstital PNA 50-80% Subsegmental consolidation 10-25%

33-50% Recurrent wheezing months to years M>F Prolonged airway hyperresponsiveness and asthma

Rely on History and PE Pulse oximetry No routine studies recommended X rays Diagnostic testing

Risk Factors <12 weeks Prematurity CHD Immunodeficiency

Bronchodilators Not routine Trial Α or β adrenergics Continue only if response is noted

Corticosteroids Not recommended routinely Ribavirin should not be used routinely

Antibacterials Only for specific indications SBI PNA AOM Use as if bronchiolitis was not present

Hydration and PO ability RR CPT Not recommended No evidence supports improvement

Oxygen <90% Do not measure sats as course improves Measure closely in children with significant heart or lung disease

Palivizumab Decreased rates of hospitalization

Hand Decontamination Most important for prevention Before and after, inanimate objects and after removing gloves Alcohol based rub preferred Educate the families

Passive Smoking Increases risk of infection Breastfeeding Protective immune factors Decreases risk of hospitalization No recommendation at this time