Clinical Features & Diagnosis & DDs & Prognosis & Prevention

Initially, URTI symptoms (e.g., copious rhinorrhea, low-grade fever, cough)

• Followed by LRTI symptoms

  • Crackles, wheezes, and/or rhonchi on auscultation

  • Severe illness: respiratory distress (usually occurs in children < 1 year of age)

    • Tachypnea or apnea

    • Prolonged expiration

    • Nasal flaring

    • Intercostal retractions

    • Cyanosis

• Often associated with poor feeding

• Bronchiolitis is a clinical diagnosis based on the patient's age (< 2 years) and the presence of classic clinical features of bronchiolitis.

• Further testing is not usually required but may be considered in patients with:

  • Severe disease, e.g., if there is concern for respiratory failure

  • Suspected complications of bronchiolitis

  • Diagnostic uncertainty to rule out differential diagnoses of bronchiolitis

• Respiratory viral panel

  • Findings

    • 60–75% are positive for RSV

    • Coinfections are present in up to one-third of those tested

Potential findings

• Normal

• Nonspecific findings, e.g., peribronchial thickening, hyperinflation of the lungs, interstitial infiltrates, atelectasis

• Superimposed complications, e.g., pneumonia

• No URTI symptoms

  • Congenital heart disease

  • Foreign body aspiration

  • Congenital airway abnormalities (e.g., vascular ring)

• Wheeze

  • Polyphonic

    • Asthma

    • Congestive heart failure secondary to congenital heart disease

  • Monophonic: foreign body aspiration

  • See also “Wheezing in children”.

• Asymmetric crackles: bacterial or viral pneumonia

• Cough

  • Pneumonia

  • Pertussis

• Neonatal fever: neonatal sepsis

• Apnea

• Respiratory failure

• Pneumonia

• Dehydration

• Otitis media

• With timely diagnosis and adequate treatment, the prognosis is good.

• Bronchiolitis in infancy is associated with an increased risk of developing asthma.

Palivizumab prophylaxis

• General principles

  • Palivizumab is a short-acting monoclonal antibody against RSV F protein.

  • Provides passive immunization to RSV infection (paramyxovirus)

  • Reduces bronchiolitis hospitalizations in infants at risk for severe bronchiolitis

• Indications [1][2]

  • Preterm birth at < 29 weeks' gestational age [1]

  • Chronic lung disease of prematurity

  • Hemodynamically significant congenital heart disease

• Consider in

  • Severely immunocompromised patients

• Administration

  • Monthly IM palivizumab during RSV season