Pediatric Infectious Diseases - Bronchiolitis

Question 1

What is bronchiolitis?

Answer 1

-Caused by viral lower respiratory tract infection in infants and young children
-Acute inflammation, edema, increased mucus

Question 2

Bronchiolitis clinical presentation

Answer 2

-Fever
-Rhinorrhea
-Cough
-Sneezing
-Increased work of breathing (nasal flare, accessory muscle breathing)
-Can progress to respiratory failure in some cases

Question 3

How long does it take bronchiolitis to resolve?

Answer 3

May take up to 2 weeks to resolve, symptoms often peak around day 5

Question 4

What causes bronchiolitis?

Answer 4

-Many different viruses cause similar symptoms
-Most common is respiratory syncytial virus (RSV)
-Others include rhinovirus, metapneumovirus, influenza, adenovirus, parainfluenza, coronavirus

Question 5

How many children are infected with RSV before 24 months?

Answer 5

90%

Question 6

Risk factors for bronchiolitis

Answer 6

-Age less than 6
-Pre-term birth
-Cyanotic or complicated CHD
-Chronic lung disease
-Weakened immune system

Question 8

What is the mainstay of treatment for bronchiolitis?

Answer 8

Supportive therapy
-Oxygen
-Hydration
-Mechanical ventilation
-ECMO

Question 9

What are some ways to prevent bronchiolitis?

Answer 9

-Hand washing
-Isolation
-“sick pods”
-Flu vaccine
-RSV specific prophylaxis

Question 10

What are the two main ways to protect babies from severe RSV disease?

Answer 10

-Vaccination of pregnant people
-Monoclonal antibodies for infants

Question 11

Who qualifies for an RSV vaccine?

Answer 11

-Administered before and during start of RSV season
-People who are 32 through 36 weeks pregnant
-Some increased risk of preterm birth in trials

Question 12

When should an RSV vaccine be given?

Answer 12

At least 14 days before delivery

Question 13

When is nirsevimab given?

Answer 13

-Birth parent did not get RSV vaccination at least 14 days before delivery
-Infants less than 8 months of age
-High risk patients may receive a second dose in second RSV season
-Only indicated for prevention of RSV but has not been studied for treatment of RSV

Question 14

How is nirsevimab dosed?

Answer 14

Weight based

Question 15

What patients qualify for a second dose of nirsevimab?

Answer 15

-Chronic lung disease of prematurity
-Chronic corticosteroid therapy, diuretic therapy, or supplemental oxygen within 6 months before the start of the second RSV season
-Severely immunocompromised children
-Hemodynamically significant congenital heart disease
-American Indian or Alaska Native children