A 9-month-old presents with 3-day history of rhinorrhea, cough, and increasing respiratory distress. On examination: RR 62/min, SpO2 91% on room air, marked subcostal and intercostal retractions, hyperinflated chest, diffuse bilateral wheeze, and fine crackles. What is the RECOMMENDED treatment for SEVERE bronchiolitis in an infant requiring hospitalization according to current evidence-based guidelines?
- A Nebulized salbutamol (bronchodilator) as first-line to relieve wheeze
- B Oral or IV dexamethasone to reduce airway inflammation
- C Nebulized 3% hypertonic saline plus IV theophylline
- D Supportive care — supplemental oxygen and nasogastric feeds; bronchodilators and steroids are not recommended ✓
Explanation
Evidence-based guidelines (AAP 2014, updated 2021; SIGN) consistently show that bronchodilators (salbutamol, epinephrine) and systemic steroids do NOT improve outcomes in bronchiolitis — multiple high-quality RCTs and meta-analyses have failed to demonstrate benefit. Hypertonic saline may modestly reduce hospital stay in admitted patients but is NOT a proven first-line therapy. The cornerstone of management is supportive care: supplemental oxygen to maintain SpO2 >90–92%, nasogastric tube feeding if the infant cannot feed adequately, and judicious fluid management. CPAP/HFNC may be used for respiratory failure.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.