A 2-month-old infant presents in January with 3 days of rhinorrhea followed by tachypnea, subcostal retractions, fine crackles, and wheeze bilaterally. Temperature is 37.9°C. SpO2 is 91% on room air. Nasal aspirate tests positive for RSV by rapid antigen test. Which intervention has the STRONGEST evidence of benefit in this infant?
- A Supplemental oxygen to maintain SpO2 ≥94% and ensure adequate hydration ✓
- B Nebulized salbutamol to relieve bronchospasm and improve oxygen saturation
- C Nebulized hypertonic saline (3%) to improve mucociliary clearance and reduce hospitalization duration
- D Nebulized adrenaline (epinephrine) as the most effective pharmacotherapy for RSV bronchiolitis
Explanation
In acute bronchiolitis (RSV), the evidence base for pharmacological interventions is weak. Current AAP and NICE guidelines recommend only supportive care as first-line: supplemental oxygen to maintain SpO2 ≥90–94% and adequate hydration (nasogastric or IV if oral intake is insufficient). Bronchodilators (salbutamol, epinephrine) have shown no consistent clinical benefit in randomized trials and are not routinely recommended. Hypertonic saline has shown modest benefit in reducing hospitalization duration in some trials but is not recommended for outpatient management. Oxygen is the single intervention with established benefit.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.