RSV bronchiolitis -- 'Tis the Season for Wheezin'
Bronchiolitis is an infection of the lower respiratory tract, most commonly caused by RSV (respiratory syncytial virus). Seasonal outbreaks of the infection occur during the winter months; from November through April in the northern hemisphere and from May through September in the southern hemisphere. In the U.S., RSV accounts for 20% of all hospital admissions due to acute respiratory infections in children under 5 years of age. By 2 years of age, almost all children have been infected by RSV; unfortunately, long-lasting immunity doesn't occur after infection, and reinfection is common, but less severe.
Initially, RSV will present with typical cold symptoms - fever, runny nose, watery eyes, and cough, usually for 1-2 days. The infection then presents with lower airway involvement, characterized by wheezing and rapid breathing (tachypnea). A child with more severe signs of respiratory distress may present with nasal flaring, rib retractions, rales (lung 'crackles'), prolonged expiration, hypoxia (oxygen deficiency) and even apnea (breathing cessation).
Care is usually supportive, as it is not clear if medications like albuterol are consistently effective at treating bronchiolitis. Usually a course of albuterol can be tried, with the parents instructed to watch for improvement in ease of breathing after the treatment. Parents can help the baby to breathe easier by keeping the baby's nasal passage as clear as possible with a nasal aspirator. A humidifier at the side of the crib can also help thin airway secretions. Feeding is another area of concern for babies with bronchiolitis, as airway congestion and narrowing can make it even more difficult for the baby to expend the energy to feed properly.
Hospitalization is not uncommon for young infants (less than 2 months of age) as well as infants with underlying heart disease, lung disease, prematurity, and immune deficiency. If a baby is hypoxic and showing signs of labored breathing and respiratory distress, admission to the hospital is necessary for close monitoring and to receive supplemental oxygen. Whether in the office or hospital setting, a probe placed on a finger or toe can accurately and non-invasively measure the oxygen saturation in the bloodstream. A reading of less than 90% will be associated with respiratory distress and will necessitate supplemental oxygen.
After babies are diagnosed with RSV bronchiolitis in the office, close follow up is warranted. Patients are usually required to return in 1-2 days for a follow-up visit to reassess the respiratory and hydration status. Typically, babies will clinically appear worse a few days after diagnosis. It would not be unusual for a baby with RSV to still have a cough a few weeks after being diagnosed.
In summary, RSV is an extremely common winter virus, which can cause breathing problems for infants. Caregivers need to be able to recognize signs of respiratory distress and to contact their healthcare providers if they suspect their baby is having difficulty breathing.
Mark C. Garabedian, M.D., F.A.A.P.
Dr. Garabedian received his medical degree from New York Medical College and completed his residency in Pediatrics at North Shore University Hospital and Cornell University Medical Center. He is board certified by the American Academy of Pediatrics. Prior to joining Bon Secours Medical Group, Dr. Garabedian was in private practice in Southampton, New York, for 16 years.
Mark C. Garabedian, M.D., F.A.A.P.
Dr. Garabedian received his medical degree from New York Medical College and completed his residency in Pediatrics at North Shore University Hospital and Cornell University Medical Center. He is board certified by the American Academy of Pediatrics. Prior to joining Bon Secours Medical Group, Dr. Garabedian was in private practice in Southampton, New York, for 16 years.
