An 8-month-old infant presents during winter with runny nose, low-grade fever, tachypnea (respiratory rate 62/min), subcostal retractions, and bilateral expiratory wheezes and fine crackles. Oxygen saturation is 93% on ambient air. Nasal swab is positive for RSV. According to AAP clinical guidelines, what is the cornerstone of management?

Answer and explanation

Correct answer: C. Supportive care with nasal suctioning and supplemental oxygen if SpO2 drops below 90%

  1. Step 1: The clinical diagnosis is acute viral bronchiolitis caused by Respiratory Syncytial Virus (RSV).
  2. Step 2: The American Academy of Pediatrics (AAP) bronchiolitis guidelines recommend supportive care as the primary management: maintaining hydration, clearing nasal secretions, and administering supplemental oxygen only if SpO2 persistently falls below 90%.
  3. Step 3: Routine use of bronchodilators, systemic corticosteroids, and antibiotics is explicitly discouraged due to lack of proven clinical efficacy.
Answer
Supportive care with nasal suctioning and supplemental oxygen if SpO2 drops below 90%.
Why not the others: 'Nebulized salbutamol and oral prednisolone' have been proven ineffective in acute bronchiolitis and are not recommended; 'Intravenous ribavirin and prophylactic ceftriaxone' are unwarranted as bacterial superinfection is rare (<1%) and ribavirin is reserved for severely immunocompromised patients; 'Routine chest physiotherapy' offers no reduction in length of stay.

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