A 6-week-old infant presents with 3 days of progressive tachypnea, subcostal retractions, nasal flaring, and diffuse expiratory wheeze. He is afebrile. CXR shows hyperinflation and perihilar haziness. HR is 150/min, SpO₂ 88% on room air. Nasopharyngeal swab PCR is positive for RSV. Which of the following therapies has PROVEN benefit in this condition?
- A Supplemental oxygen and supportive care; high-flow nasal cannula if hypoxic ✓
- B Nebulized epinephrine + prednisolone to reduce bronchospasm
- C Nebulized hypertonic saline (3%) to improve mucociliary clearance
- D Oral salbutamol to reverse bronchospasm
Explanation
RSV bronchiolitis is the most common cause of lower respiratory tract infection in infants. Per AAP 2014 (updated 2022) guidelines, there is NO proven benefit from bronchodilators (salbutamol, nebulized epinephrine), corticosteroids, antibiotics, or ribavirin in typical bronchiolitis. The only therapies with proven benefit are supplemental oxygen for SpO₂ <90–92% and adequate hydration (NG/IV if unable to feed). High-flow nasal cannula (HFNC) oxygen therapy reduces the need for mechanical ventilation in moderate-severe bronchiolitis and is standard care in hospitalized cases. Hypertonic saline has shown modest benefit in reducing hospital length of stay in some meta-analyses but is not a definitive therapy.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.