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Difficulty: EasyPediatric Respiratory Disorders

During a mid-December clinic visit, a 5-month-old female infant is evaluated for a cough and rapid breathing. The mother reports that the infant developed sneezing and a runny nose four days ago. Since yesterday, the cough has worsened. Vital signs include a temperature of 37.6°C (99.7°F), heart rate of 135/min, respiratory rate of 56/min, and oxygen saturation of 97% on room air. The infant is alert and feeding well. Lung auscultation reveals scattered end-expiratory wheezes and mild intercostal retractions bilaterally. Which of the following is the most appropriate management for this patient?

  1. Observation and reassurance regarding adequate fluid intakeAnswer
  2. B
    Trial of inhaled short-acting beta-agonists
  3. C
    Systemic glucocorticoid therapy
  4. D
    Empiric broad-spectrum antibiotic therapy
  5. E
    Routine screening chest radiograph

Answer

Observation and reassurance regarding adequate fluid intake
This patient presents with classic signs of mild viral bronchiolitis (rhinorrhea, low-grade fever, wheezing, and mild work of breathing in an infant during winter). Because she is well-hydrated and maintaining normal oxygen saturation on room air, the standard of care is entirely supportive, focusing on maintaining adequate hydration and monitoring.

Step-by-Step Solution

1
Analyze the patient's age and clinical presentation.
A 5-month-old infant in winter with an upper respiratory prodrome progressing to wheezing and mild retractions.
To establish the most likely clinical diagnosis based on the seasonal pattern and symptomatology.
2
Identify the disease entity.
The constellation of findings is classic for acute viral bronchiolitis, most commonly caused by respiratory syncytial virus (RSV).
Bronchiolitis is a clinical diagnosis primarily affecting infants under 2 years of age.
3
Determine the appropriate severity and management.
The patient has normal oxygen saturation (>90%) and is feeding well despite mild retractions. Management is supportive.
Mild bronchiolitis does not require pharmacologic intervention or routine imaging.

Key Concept

Diagnosis and management of mild acute viral bronchiolitis in infants.
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Topics

Pediatric Respiratory Disorders

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