A 3-month-old infant in December presents with 2 days of coryzal symptoms followed by tachypnoea (70 breaths/min), subcostal and intercostal retractions, wheeze, and bilateral crepitations. SpO2 is 90% on room air. Which is the treatment backed by strongest evidence?
- A Nebulised salbutamol 2.5 mg every 4 hours
- B Nebulised adrenaline (epinephrine) 3 mg
- C Supportive care: supplemental O2 to maintain SpO2 ≥94%, nasal suctioning, adequate hydration ✓
- D IV dexamethasone 0.15 mg/kg
Explanation
Bronchiolitis (most commonly caused by RSV) in infants is managed with supportive care as the evidence-based treatment. High-quality meta-analyses and the AAP 2014 guideline (updated 2023) confirm that bronchodilators (salbutamol, adrenaline), systemic corticosteroids, ribavirin, and chest physiotherapy do NOT improve outcomes and are NOT recommended. Supplemental oxygen to maintain SpO2 ≥90–94%, nasal suctioning for patency, and ensuring adequate hydration (nasogastric/IV if needed) are the pillars of management. High-flow nasal cannula (HFNC) may reduce intubation in moderate-severe disease. Prophylactic palivizumab (anti-RSV monoclonal antibody) is given to high-risk premature infants before RSV season.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.