Pedemy All toolsAnswer one question at a time. The result gives disposition, supportive care and what to avoid. Tap any earlier answer to change it.
This pathway helps clinicians assess infants under 2 years with bronchiolitis and decide on disposition. It gives supportive care steps, what to avoid, and prevention advice for the next RSV season.
It first confirms the age and a typical picture: a viral cold for 1 to 3 days followed by cough, fast breathing, wheeze or crackles. Children 2 years or older, or with atypical features, are steered to other diagnoses. Severe signs, including apnea, SpO2 persistently below 90% on room air, severe retractions or grunting, inability to feed, lethargy or a breathing rate above 70, lead to admission and consideration of PICU. Risk factors such as age under 12 weeks, birth before 35 weeks, heart or chronic lung disease, immunodeficiency or neuromuscular disease, together with feeding and oxygen saturation, decide between home care, observation and ward admission.
Results list supportive care such as nasal suction, oxygen to keep SpO2 90% or higher, high-flow nasal cannula and isotonic fluids, plus tests and treatments not to use routinely, including albuterol, steroids and chest x-ray. Prevention covers nirsevimab and maternal RSV vaccine. It follows the AAP clinical practice guideline (Pediatrics 2014).
Admit for any severe sign, such as apnea, cyanosis, SpO2 persistently below 90% on room air, severe retractions, inability to feed, lethargy or breathing rate above 70, or for poor feeding or SpO2 below 90%. Infants with risk factors are observed, including at least one feed, before discharge.
No. Under the AAP 2014 guideline, albuterol, racemic epinephrine, corticosteroids, hypertonic saline in the emergency department, antibiotics without a documented bacterial infection, chest x-ray, viral testing and chest physiotherapy are not used routinely.
For infants under 8 months in their first RSV season, nirsevimab is 50 mg IM if under 5 kg or 100 mg if 5 kg or more. High-risk children 8–19 months in their second season receive 200 mg. Infants usually do not need it if the mother received the RSV vaccine at 32–36 weeks.
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