A 6-week-old infant presents with 3 days of rhinorrhoea followed by increasing respiratory distress, wheeze, and feeding difficulty. O2 saturation is 90%. Chest X-ray shows hyperinflation with scattered atelectasis. Nasopharyngeal aspirate PCR is positive for RSV. What is the EVIDENCE-BASED first-line treatment?
- A Nebulized salbutamol + IV hydrocortisone
- B Nebulized adrenaline + oral prednisolone
- C Nebulized 3% hypertonic saline + supportive care (oxygen, feeding support) ✓
- D IV ribavirin + IVIG
Explanation
Acute bronchiolitis in infants is primarily managed supportively — oxygen to maintain SpO2 >92%, adequate hydration (NG or IV if feeding is poor), and careful monitoring. Nebulized 3% hypertonic saline has shown modest benefit in reducing hospitalization duration and improving clinical severity scores. Nebulized salbutamol and adrenaline have NOT shown consistent benefit in randomized trials of bronchiolitis and are not recommended routinely. Systemic corticosteroids have no proven benefit in bronchiolitis. IV ribavirin is used only in severely immunocompromised patients with RSV (transplant recipients) and is not standard.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.