A 3-month-old infant presents in winter with her first episode of wheeze, intercostal recession, and nasal flaring. SpO2 87% on room air. Nasopharyngeal swab is RSV-positive. She weighs 4.5 kg and was born at 32 weeks gestation. The most evidence-based pharmacological treatment that has demonstrated benefit in severe RSV bronchiolitis in a high-risk premature infant is:
- A Supplemental oxygen and supportive care; consider high-flow nasal cannula for SpO2 <90% ✓
- B Nebulized salbutamol 2.5 mg every 4 hours
- C Nebulized 3% hypertonic saline for airway clearance
- D IV dexamethasone 0.6 mg/kg for airway inflammation
Explanation
Evidence-based management of RSV bronchiolitis is predominantly supportive. Multiple RCTs show no benefit from bronchodilators (salbutamol, adrenaline), hypertonic saline, or corticosteroids in bronchiolitis. Supplemental oxygen is the cornerstone treatment; high-flow nasal cannula (HFNC) oxygen (e.g., Optiflow) has demonstrated benefit in reducing escalation to mechanical ventilation for moderate-to-severe bronchiolitis (SpO2 <90%, SpO2 <92% in high-risk premature infants). This premature infant (32 weeks) with SpO2 87% warrants supplemental oxygen with consideration for HFNC. Palivizumab prophylaxis is recommended for prevention in high-risk premature infants, but this infant is now presenting with disease.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.