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Clinical management for RSV bronchiolitis and pneumonia is
similar. Approximately 1% of all patients with RSV will require
hospitalization. Admission is based on historical presentation, clinical
findings, or laboratory and radiology results.1
Infants younger than 3 months or with less than 34 weeks gestation, or
children with chronic lung or cardiac disease usually are admitted to the
hospital depending on their respiratory status. Clinically, infants or
children with respiratory rates higher than 70, wheezing and respiratory
distress, a toxic and lethargic appearance, an oxygen saturation lower than
95% on room air, atelectasis or consolidation on chest radiograph, and
hypercarbia warrant admission. Previously healthy patients generally are
discharged within 24 to 72 hours, although infants and children with long-term
heart and lung disease often have long and complicated hospital stays
secondary to their inability to compensate for the alteration in ventilation28.
The primary treatment approach for any RSV infection is supportive, consisting
of continuous monitoring, intravenous hydration, and administration of oxygen
to correct hypoxemia. Areas of management on which there is varied agreement
include the use of bronchodilators, antiviral therapy, corticosteroids,
immunoprophylaxis, and routine testing for RSV antigens in infants
hospitalized for RSV bronchiolitis.1
Pharmacologic treatments continue to be used, although there is limited
evidence of their effectiveness.2–6
The treatment remains primarily supportive and aimed at symptom reduction. An
effective treatment protocol must reduce obstructive respiratory symptoms,
prevent recurrent symptoms, and be safe and cost effective.
Bronchodialators and corticosteroids and Ribavirin may be effective in
improving clinical symptoms, however they are associated with an annual cost
of more than $37 million in the United States.
Acute bronchiolitis early in life is associated with subsequent wheezing as
the child grows. Described as a significant risk factor for asthma and
wheezing,31
RSV increases cholinergic stimulation of the smooth muscle in the airway and
the inflammatory response, mediated by a neuropeptide.1,32
The monoclonal antibody developed for use against the RSV protein, palivizumab, given either
before or within 3 days of infection, has inhibited the inflammation in rats.33
This method may hold promise for the prevention of RSV infections.
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