Morning Report

July 29, 2010

Morning Report

Most common pathogen causing lower airway disease in infants and toddlers

90,000 hospitalizations/year

$700 million/year for children <1y

RSV

Human to HumanDecember to MarchNo long-term immunityUniversal infection by 2y

40% lower airway disease

RSV

RhinitisTachypneaWheezingCoughCracklesAccessory muscle useNasal flaring

RSV

Acute inflammationEdema and necrosis of

epithelial cells lining small airways

Increased mucus production

Bronchospasm

RSV

CXR

Peribronchial thickening or interstital PNA50-80%

Subsegmental consolidation10-25%

RSV

33-50%Recurrent wheezing

months to years

M>FProlonged airway

hyperresponsiveness and asthma

RSV

Rely on History and PEPulse oximetry

No routine studies recommendedX raysDiagnostic testing

Recommendation 1

Risk Factors<12 weeksPrematurityCHDImmunodeficiency

Recommendation 1

BronchodilatorsNot routineTrial

Α or β adrenergicsContinue only if

response is noted

Recommendation 2

CorticosteroidsNot recommended routinely

Ribavirin should not be used routinely

Recommendation 3

Recommendation 4

Antibacterials

Only for specific indicationsSBIPNAAOM

Use as if bronchiolitis was not present

Recommendation 5

Hydration and PO ability60-70 RR

CPTNot recommended

No evidence supports improvement

Recommendation 6

Oxygen<90%Do not measure sats

as course improvesMeasure closely in

children with significant heart or lung disease

Recommendation 7

PalivizumabDecreased rates of hospitalization

Recommendation 8

Hand Decontamination

Most important for preventionBefore and after, inanimate

objects and after removing gloves

Alcohol based rub preferred

Educate the families

Recommendation 9

Passive SmokingIncreases risk of infection

BreastfeedingProtective immune factorsDecreases risk of hospitalization

No recommendation at this time

Recommendation 10

Recommendation 11 - CAM