A 3-month-old infant presents with a 3-day history of rhinorrhea, increasing wheeze, tachypnea (respiratory rate 72/min), subcostal retractions, and oxygen saturation 88% on room air. Chest X-ray shows hyperinflation with bilateral perihilar streaking. He is too tired to feed. What is the most appropriate immediate management?
- A Supplemental oxygen and nasogastric tube feeding, with monitoring ✓
- B Nebulized salbutamol and ipratropium bromide
- C IV methylprednisolone and nebulized adrenaline
- D Oral dexamethasone and nebulized hypertonic saline
Explanation
Bronchiolitis (most commonly RSV) management is primarily supportive: supplemental oxygen to maintain SpO2 ≥92–95%, and ensuring adequate hydration (nasogastric feeds if the infant cannot feed adequately due to respiratory distress). Neither bronchodilators (salbutamol, ipratropium) nor corticosteroids have been shown to reduce hospital stay or severity in meta-analyses and are not recommended by AAP guidelines for bronchiolitis. Hypertonic saline may modestly reduce hospital stay but is not first-line over oxygen and hydration. High-flow nasal cannula (HFNC) is used if conventional oxygen fails.
Reference: Ghai Essential Pediatrics, 10th ed.
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Written and medically reviewed by the StethoPrep medical team.