A 10-month-old infant presents in December with wheeze, subcostal retractions, and respiratory rate of 66/min. CXR shows hyperinflation with peribronchial thickening. SpO2 is 91%. RSV antigen test is positive. Current EVIDENCE-BASED guidance for the management of this first episode of bronchiolitis recommends:
- A Nebulized salbutamol 0.15 mg/kg 4-hourly
- B Oral prednisolone 1 mg/kg/day for 5 days
- C Nebulized 3% hypertonic saline and supportive care with oxygen ✓
- D Intravenous ribavirin for RSV bronchiolitis
Correct answer: C. Nebulized 3% hypertonic saline and supportive care with oxygen
Explanation
Current evidence (AAP/NICE guidelines) does not support bronchodilators, steroids, or routine antibiotics for bronchiolitis. Nebulized 3% hypertonic saline reduces airway edema and mucus viscosity and has modest evidence for reducing hospital length of stay and clinical scores, though its routine use is still debated. Supportive care with supplemental oxygen (target SpO2 ≥92%), adequate hydration, and positioning remains the cornerstone. Ribavirin is used only in severe immunocompromised cases and is not standard therapy.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.