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Updated: Dec 25 2021


  • Snapshot
    • A 6-month old infant is seen in the emergency room for wheezing. His breathing has become increasingly difficult over the past 2-3 days. He has also had a worsening cough, subjective fevers, and rhinitis. Today, his parents took him to the pediatrician’s office, where his oxygen saturation was 80% on room air. He was sent immediately from the clinic to the emergency room via ambulance, where he was given supplemental oxygen. On physical exam, he has increased work of breath with nasal flaring, grunting, and intercostal retractions. He also has bilateral wheezes. His parents are counseled on the possibility of further interventions if his oxygen saturation does not improve.
  • Introduction
    • Clinical definition
      • a viral respiratory infection that causes wheezing and increased respiratory effort in children and infants
    • Prevention
      • palivizumab
        • mechanism
          • monoclonal antibody against F protein, a key protein that RSV utilizes to infect patients
        • indication
          • premature infants
          • babies at risk of severe infection (i.e., immunocompromised status)
  • Epidemiology
    • Incidence
      • more common in the winter
    • Demographics
      • children < 2 years of age
    • Risk factors
      • asthma
      • day care centers
      • exposure to air pollutants such as cigarette smoke
      • cardiopulmonary disease
      • immunodeficiency
      • congenital heart disease
      • premature infants
  • Etiology
    • Respiratory syncytial virus (RSV)
      • most common
      • an enveloped, linear, single-stranded, negative-sense paramyxovirus with a helical capsid
    • Rhinovirus
    • Parainfluenza virus
    • Influenza virus
    • Coronavirus
    • Pathogenesis
      • the virus initially infects the upper respiratory tract and travels to the lower respiratory tract within a few days
      • edema of submucosa causes an obstructive pathology in the lungs, causing wheezing and respiratory distress
  • Presentation
    • Symptoms
      • low-grade fever
      • congestion
      • cough
      • poor feeding
      • grunting
    • Physical exam
      • tachypnea
      • bilateral wheezing
      • prolonged expiratory phase
      • increased work of breath
        • nasal flaring
        • intercostal retractions
  • Studies
    • Labs
      • rapid antigen test
  • Differential
    • Asthma
      • distinguishing factors
        • typically recurrent episodes with identifiable triggers
        • history of atopy in the patient or family
    • Foreign body aspiration
      • distinguishing factor
        • unilateral wheezing
    • Making the diagnosis
      • most cases are clinically diagnosed
  • Treatment
    • Conservative
      • supportive care
        • indication
          • all patients
        • modalities
          • hydration
          • supplemental oxygen
  • Complications
    • Hypoxemic respiratory failure
      • treatments
        • oxygen
        • mechanical ventilation
  • Prognosis
    • Typically self-limited
    • More severe in infants < 6 months of age
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