UMEM Educational Pearls

Title: Summer Surprise...RSV Bronchiolitis

Keywords: RSV, bronchiolitis (PubMed Search)

Posted: 8/6/2021 by Rachel Wiltjer, DO
Click here to contact Rachel Wiltjer, DO

Generally a seasonal illness that circulates in fall/winter (Maryland’s season is October-April)
Following low incidence since April 2020, there is current ongoing circulation outside of the normal seasonal patterns
Updated regional trends are available via the National Respiratory and Enteric Virus Surveillance System (https://www.cdc.gov/surveillance/nrevss/rsv/index.html)
Causes upper respiratory illness characterized by copious nasal secretions which may cause increased work of breathing and necessitate hospitalization
Severity tends to peak at around day 5 of illness
In infants younger than 6 months, may also present with poor feeding, lethargy, or apnea
Risk of apnea is highest in premature infants (post conception age <48 weeks) and infants under 1 month of age
Routine administration of albuterol has not been shown to have benefit, the most recent AAP guidelines have a recommendation against trial of albuterol (common practices continue to be variable). It should be noted that children with severe disease were excluded from the studies used to make this recommendation.
Hypertonic saline administration has not shown to be helpful in the ED setting, but may decrease length of stay in patients being admitted
Consider admission for persistent tachypnea, hypoxia, inability to adequately feed, moderate to severe increased work of breathing at rest, or apnea

References

CDC. Increased Interseasonal Respiratory Syncytial Virus (RSV) Activity in Parts of the Southern United States. Health Alert Network. Published online June 10, 2021.

Ralston, S., Lieberthal, A., et al. Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis. Pediatrics. Nov 2014. 134(5) e1474-1502.