A 6-week-old infant presents in winter with wheezing, subcostal retractions, nasal flaring, and SpO2 89% on room air. Nasopharyngeal aspirate PCR is positive for RSV. Which statement about bronchiolitis management is CORRECT?
- A Nebulized salbutamol should be given as it reliably improves oxygenation
- B Hypertonic (3%) saline nebulization is the recommended first-line treatment for all bronchiolitis
- C Supplemental oxygen to maintain SpO2 ≥90–92% and adequate hydration are the mainstays of management ✓
- D Systemic steroids are recommended to shorten hospital duration
Correct answer: C. Supplemental oxygen to maintain SpO2 ≥90–92% and adequate hydration are the mainstays of management
Explanation
RSV bronchiolitis management is primarily supportive: supplemental oxygen to maintain SpO2 ≥90% (some guidelines use 92%), nasogastric or IV fluids for hydration if unable to feed, and positioning. Multiple Cochrane reviews and AAP/NICE guidelines do not recommend routine bronchodilators (salbutamol, epinephrine), systemic steroids, or antibiotics, as these do not reduce hospitalization duration or improve outcomes. Hypertonic saline shows modest benefit only in hospitalized patients per some meta-analyses but is not universally recommended as first-line.
Reference: Ghai Essential Pediatrics, 10th ed.
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