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Morning Report

Morning Report. July 29, 2010. RSV. Most common pathogen causing lower airway disease in infants and toddlers 90,000 hospitalizations/year $700 million/year for children <1y. RSV. Human to Human December to March No long-term immunity Universal infection by 2y 40% lower airway disease.

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Morning Report

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  1. Morning Report July 29, 2010

  2. RSV • Most common pathogen causing lower airway disease in infants and toddlers • 90,000 hospitalizations/year • $700 million/year for children <1y

  3. RSV • Human to Human • December to March • No long-term immunity • Universal infection by 2y • 40% lower airway disease

  4. RSV • Rhinitis • Tachypnea • Wheezing • Cough • Crackles • Accessory muscle use • Nasal flaring

  5. RSV • Acute inflammation • Edema and necrosis of epithelial cells lining small airways • Increased mucus production • Bronchospasm

  6. RSV • CXR • Peribronchialthickening or interstital PNA • 50-80% • Subsegmentalconsolidation • 10-25%

  7. RSV • 33-50% • Recurrent wheezing months to years • M>F • Prolonged airway hyperresponsiveness and asthma

  8. Recommendation 1 • Rely on History and PE • Pulse oximetry • No routine studies recommended • X rays • Diagnostic testing

  9. Recommendation 1 • Risk Factors • <12 weeks • Prematurity • CHD • Immunodeficiency

  10. Recommendation 2 • Bronchodilators • Not routine • Trial • Α or βadrenergics • Continue only if response is noted

  11. Recommendation 3 • Corticosteroids • Not recommended routinely • Ribavirin should not be used routinely Recommendation 4

  12. Recommendation 5 • Antibacterials • Only for specific indications • SBI • PNA • AOM • Use as if bronchiolitis was not present

  13. Recommendation 6 • Hydration and PO ability • 60-70 RR • CPT • Not recommended • No evidence supports improvement

  14. Recommendation 7 • Oxygen • <90% • Do not measure sats as course improves • Measure closely in children with significant heart or lung disease

  15. Recommendation 8 • Palivizumab • Decreased rates of hospitalization

  16. Recommendation 9 • Hand Decontamination • Most important for prevention • Before and after, inanimate objects and after removing gloves • Alcohol based rub preferred • Educate the families

  17. Recommendation 10 • Passive Smoking • Increases risk of infection • Breastfeeding • Protective immune factors • Decreases risk of hospitalization • No recommendation at this time Recommendation 11 - CAM

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