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Bronchiolitis Clinical Presentation

  • Author: Lucian Kenneth DeNicola, MD, MS, FAAP, FCCM; Chief Editor: Russell W Steele, MD  more...
 
Updated: May 16, 2016
 

History

The history and the physical examination form the primary basis for the diagnosis of bronchiolitis.

Because bronchiolitis primarily affects young infants, clinical manifestations are initially subtle. Infants may become increasingly fussy and have difficulty feeding during the 2 to 5-day incubation period.[3] A low-grade fever, usually less than 101.5°F, and increasing coryza and congestion usually follow the incubation period. In older children and adults, as well as in up to 60% of infants, respiratory syncytial virus (RSV) infection is generally confined to the upper airway and does not progress further.[89]

Over a period of 2-5 days, RSV infection progresses from the upper to the lower respiratory tract, and this progression leads to the development of cough, dyspnea, wheezing, and feeding difficulties. When the patient is brought to medical attention, the fever has usually resolved. Infants younger than 1 month may present as hypothermic.[4] Severe cases progress to respiratory distress with tachypnea, nasal flaring, retractions, irritability, and, possibly, cyanosis.

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Physical Examination

Examination often reveals the following:

  • Tachypnea
  • Tachycardia
  • Fever (38-39°C)
  • Retractions
  • Fine rales (47%)
  • Diffuse, fine wheezing

The diagnosis is made on the basis of age and seasonal occurrence, tachypnea, and the presence of profuse coryza and fine rales, wheezes, or both upon auscultation of the lungs. Some practitioners exclude RSV infection in the absence of coryza.

Hypoxia is the best predictor of severe illness and correlates best with the degree of tachypnea (>50 breaths/min). The degree of wheezing or retractions correlates poorly with hypoxia. First-time infections are usually most severe; subsequent attacks are generally milder, particularly in older children.

Apnea occurs early in the course of the disease and may be the presenting symptom. Nonobstructive central apnea occurs during quiet sleep and is associated with increases in the apnea index (the percentage of time the baby spends apneic), apnea attack rate (the number of episodes of apnea per unit time), and apnea percentage (the distribution of episodes of apnea in a given sleep state).

Apnea rarely lasts longer than a few days; however, approximately 10% of apneic patients require intubation and mechanical ventilation. The observation that very few cases of sudden infant death syndrome are attributable to bronchiolitis suggests that most infants with apnea self-stimulate and recover spontaneously. Mild RSV disease in young infants is not an indication for hospitalization to observe for apnea.[90, 91, 92, 93, 94, 95]

In a systematic review, Ralston et al found that the overall incidence of apnea ranged from 1.2% to 23.8% in infants hospitalized with RSV bronchiolitis.[90] Further analysis showed that apnea occurred more commonly in preterm infants (range, 4.9-37.5%) than in full-term infants (range, 0.5-12.4%).

Kneyber et al found that the strongest independent risk factor for RSV-associated apnea was age younger than 2 years.[96] Apnea at admission was found to increase the risk of recurrent apnea. Additionally, the likelihood of mechanical ventilation significantly increased in children who suffered from recurrent apnea.

Using the criteria of (1) full-term younger than 1 month, (2) preterm (< 37 weeks gestational age) and younger than 48 weeks postconceptional age, and (3) observed apnea, Willwerth et al found the incidence of in-hospital apnea to be only 2.7%.[91]

Nonrespiratory manifestations of RSV infections include otitis media, myocarditis, supraventricular and ventricular dysrhythmias, and the syndrome of inappropriate antidiuretic hormone secretion (SIADH).[97, 98]

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Complications

With bronchiolitis, as with any disease, various complications are possible, including those caused by therapy. In most cases, the disease is mild and self-limited. However, in infants who are immunosuppressed and those with preexisting heart or lung disease, RSV bronchiolitis can result in any of the following[97, 99, 100] :

A possible association with asthma has been reported.[101, 102, 103, 104] RSV infections have been associated with the development of asthma, with an odds ratio of 4.3 in children aged 11 years or younger. However, because virtually all children encounter an RSV infection during the first 2-3 years of life, this association may reflect a multifactorial etiology or a genetic predisposition.

Genetic variation in the interleukin (IL)–8 promoter region has been associated with susceptibility to severe bronchiolitis. Family-based association revealed that the IL-8 variant was transmitted significantly more often than expected in children who wheezed after the episode of bronchiolitis. The effect was not observed in a group of children who had bronchiolitis but did not develop wheezing.

This association was significantly more frequent in patients with postbronchiolitis wheeze than in the general population; thus, a genetic predisposition to wheeze after severe RSV bronchiolitis is suggested.[15, 81] Some studies suggest that human metapneumovirus (hMPV) or coinfection with RSV and hMPV contribute to the likelihood of asthma in later years.[33]

As many as 1% of previously healthy children and 3% of developmentally impaired children with bronchiolitis experience neurologic complications. These include seizures, encephalopathy with hypotonia, irritability, and abnormal tone. The long-term prognosis for these children is still unknown.[105]

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Contributor Information and Disclosures
Author

Lucian Kenneth DeNicola, MD, MS, FAAP, FCCM Professor, Department of Pediatrics, University of Florida Health Science Center at Jacksonville

Lucian Kenneth DeNicola, MD, MS, FAAP, FCCM is a member of the following medical societies: American Academy of Pediatrics, American College of Critical Care Medicine, Florida Medical Association, Society of Critical Care Medicine, Florida Chapter of The American Academy of Pediatrics, Florida Pediatric Society

Disclosure: Nothing to disclose.

Coauthor(s)

Nizar F Maraqa, MD, FAAP Associate Professor of Pediatrics, Fellowship Program Director, Division of Pediatric Infectious Diseases and Immunology, University of Florida College of Medicine at Jacksonville

Nizar F Maraqa, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, Pediatric Infectious Diseases Society

Disclosure: Reviewer for: MedStudy Corporation.

John Udeani, MD, FAAEM Assistant Professor, Department of Emergency Medicine, Charles Drew University of Medicine and Science, University of California, Los Angeles, David Geffen School of Medicine

John Udeani, MD, FAAEM is a member of the following medical societies: American Academy of Emergency Medicine, American College of Emergency Physicians

Disclosure: Nothing to disclose.

Haidee T Custodio, MD Assistant Professor, Department of Pediatrics, Division of Pediatric Infectious Diseases, University of South Alabama College of Medicine

Haidee T Custodio, MD is a member of the following medical societies: American Academy of Pediatrics, Infectious Diseases Society of America, Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Chief Editor

Russell W Steele, MD Clinical Professor, Tulane University School of Medicine; Staff Physician, Ochsner Clinic Foundation

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, Southern Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

Kirsten A Bechtel, MD Associate Professor, Department of Pediatrics, Yale University School of Medicine; Attending Physician, Department of Pediatric Emergency Medicine, Yale-New Haven Children's Hospital

Kirsten A Bechtel, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Michael Gayle, MBBS, FRCPC, FAAP, FCCM Co-Medical Director of Pediatric Transport, Medical Director of Pediatric Sedation Service, Associate Professor, Department of Pediatrics, University of Florida at Jacksonville Health Science Center

Disclosure: Nothing to disclose.

Mark Louden, MD, FACEP Assistant Medical Director, Emergency Department, Duke Raleigh Hospital

Mark Louden, MD, FACEP is a member of the following medical societies: American Academy of Emergency Medicine and American College of Emergency Physicians

Disclosure: Nothing to disclose.

Zab Mosenifar, MD Director, Division of Pulmonary and Critical Care Medicine, Director, Women's Guild Pulmonary Disease Institute, Professor and Executive Vice Chair, Department of Medicine, Cedars Sinai Medical Center, University of California, Los Angeles, David Geffen School of Medicine

Zab Mosenifar, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, and American Thoracic Society

Disclosure: Nothing to disclose.

Charles I Ojielo, MD Assistant Professor of Medicine, Rush Medical College; Consulting Staff, Resident Education Coordinator, Department of Pulmonary and Critical Care Medicine, John H Stroger Hospital of Cook County/Rush University Medical Center

Charles I Ojielo, MD is a member of the following medical societies: American College of Physicians, American Medical Association, and American Thoracic Society

Disclosure: Nothing to disclose.

Stephen P Peters, MD, PhD, FACP, FAAAAI, FCCP, FCPP Professor of Genomics and Personalized Medicine Research, Internal Medicine, and Pediatrics, Associate Director, Center for Genomics and Personalized Medicine Research, Director of Research, Section on Pulmonary, Critical Care, Allergy and Immunologic Diseases, Wake Forest University School of Medicine

Stephen P Peters, MD, PhD, FACP, FAAAAI, FCCP, FCPP is a member of the following medical societies: American Academy of Allergy Asthma and Immunology, American Association of Immunologists, American College of Chest Physicians, American College of Physicians, American Federation for Medical Research, American Thoracic Society, and Sigma Xi

Disclosure: See below for list of all activities None None

Mark R Schleiss, MD American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota Medical School

Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Wayne Wolfram, MD, MPH Associate Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center

Wayne Wolfram, MD, MPH is a member of the following medical societies: American Academy of Emergency Medicine, American Academy of Pediatrics, and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

References
  1. Barclay L. AAP Updates Guidelines on Bronchiolitis in Young Children. Medscape Medical News. Available at http://www.medscape.com/viewarticle/833884.. Accessed: November 1, 2014.

  2. Ralston SL, Lieberthal AS, Meissner HC, Alverson BK, Baley JE, Gadomski AM, et al. Clinical Practice Guideline: The Diagnosis, Management, and Prevention of Bronchiolitis. Pediatrics. 2014 Oct 27. [Medline].

  3. Edelson PJ. Respiratory syncytial virus pneumonia. Pediatric Emergency Casebook. New York: World Health Communications Inc.; 1985. 1-15.

  4. Njoku DB, Kliegman RM. Atypical extrapulmonary presentations of severe respiratory syncytial virus infection requiring intensive care. Clin Pediatr (Phila). 1993 Aug. 32(8):455-60. [Medline].

  5. [Guideline] Diagnosis and management of bronchiolitis. Pediatrics. 2006 Oct. 118(4):1774-93. [Medline].

  6. Wegner S, Vann JJ, Liu G, Byrns P, Cypra C, Campbell W. Direct cost analyses of palivizumab treatment in a cohort of at-risk children: evidence from the North Carolina Medicaid Program. Pediatrics. 2004 Dec. 114(6):1612-9. [Medline].

  7. Counihan ME, Shay DK, Holman RC, Lowther SA, Anderson LJ. Human parainfluenza virus-associated hospitalizations among children less than five years of age in the United States. Pediatr Infect Dis J. 2001 Jul. 20(7):646-53. [Medline].

  8. Bada C, Carreazo NY, Chalco JP, Huicho L. Inter-observer agreement in interpreting chest X-rays on children with acute lower respiratory tract infections and concurrent wheezing. Sao Paulo Med J. 2007 May 3. 125(3):150-4. [Medline].

  9. Unger S, Cunningham S. Effect of oxygen supplementation on length of stay for infants hospitalized with acute viral bronchiolitis. Pediatrics. 2008 Mar. 121(3):470-5. [Medline].

  10. AHRQ Publication Number 03-E009, January 2003. Agency for Healthcare Research and Quality, Rockville, MD. Management of Bronchiolitis in Infants and Children. Summary, Evidence Report/Technology Assessment: Number 69. US Department of Health and Human Services. Available at http://www.ahrq.gov/clinic/epcsums/broncsum.htm. Accessed: February 28, 2010.

  11. Epler GR, Colby TV, McLoud TC, Carrington CB, Gaensler EA. Bronchiolitis obliterans organizing pneumonia. N Engl J Med. 1985 Jan 17. 312(3):152-8. [Medline].

  12. Dornelles CT, Piva JP, Marostica PJ. Nutritional status, breastfeeding, and evolution of Infants with acute viral bronchiolitis. J Health Popul Nutr. 2007 Sep. 25(3):336-43. [Medline].

  13. Downham MA, Scott R, Sims DG, Webb JK, Gardner PS. Breast-feeding protects against respiratory syncytial virus infections. Br Med J. 1976 Jul 31. 2(6030):274-6. [Medline].

  14. Tristram DA, Welliver RC. Bronchiolitis. Long SS, Pickering LK, Prober CG. Principles and Practice of pediatric Infectious Diseases. 2nd. New York: Churchill Livingstone; 2003. 213.

  15. McNamara PS, Flanagan BF, Baldwin LM, et al. Interleukin 9 production in the lungs of infants with severe respiratory syncytial virus bronchiolitis. Lancet. 2004 Mar 27. 363(9414):1031-7. [Medline].

  16. McNamara PS, Flanagan BF, Hart CA, Smyth RL. Production of chemokines in the lungs of infants with severe respiratory syncytial virus bronchiolitis. J Infect Dis. 2005 Apr 15. 191(8):1225-32. [Medline].

  17. Johnson JE, Gonzales RA, Olson SJ, Wright PF, Graham BS. The histopathology of fatal untreated human respiratory syncytial virus infection. Mod Pathol. 2007 Jan. 20(1):108-19. [Medline].

  18. Marguet C, Bocquel N, Benichou J, et al. Neutrophil but not eosinophil inflammation is related to the severity of a first acute epidemic bronchiolitis in young infants. Pediatr Allergy Immunol. 2008 Mar. 19(2):157-65. [Medline].

  19. Henderson FW, Collier AM, Clyde WA Jr, Denny FW. Respiratory-syncytial-virus infections, reinfections and immunity. A prospective, longitudinal study in young children. N Engl J Med. 1979 Mar 8. 300(10):530-4. [Medline].

  20. Fodha I, Vabret A, Ghedira L, et al. Respiratory syncytial virus infections in hospitalized infants: association between viral load, virus subgroup, and disease severity. J Med Virol. 2007 Dec. 79(12):1951-8. [Medline].

  21. Hall CB, Walsh EE, Schnabel KC, et al. Occurrence of groups A and B of respiratory syncytial virus over 15 years: associated epidemiologic and clinical characteristics in hospitalized and ambulatory children. J Infect Dis. 1990 Dec. 162(6):1283-90. [Medline].

  22. McConnochie KM, Hall CB, Walsh EE, Roghmann KJ. Variation in severity of respiratory syncytial virus infections with subtype. J Pediatr. 1990 Jul. 117(1 Pt 1):52-62. [Medline].

  23. Papadopoulos NG, Gourgiotis D, Javadyan A, et al. Does respiratory syncytial virus subtype influences the severity of acute bronchiolitis in hospitalized infants?. Respir Med. 2004 Sep. 98(9):879-82. [Medline].

  24. Hall CB, Douglas RG Jr, Geiman JM. Respiratory syncytial virus infections in infants: quantitation and duration of shedding. J Pediatr. 1976 Jul. 89(1):11-5. [Medline].

  25. Mansbach JM, McAdam AJ, Clark S, Hain PD, Flood RG, Acholonu U. Prospective multicenter study of the viral etiology of bronchiolitis in the emergency department. Acad Emerg Med. 2008 Feb. 15(2):111-8. [Medline].

  26. Williams JV, Harris PA, Tollefson SJ, Halburnt-Rush LL, Pingsterhaus JM, Edwards KM. Human metapneumovirus and lower respiratory tract disease in otherwise healthy infants and children. N Engl J Med. 2004 Jan 29. 350(5):443-50. [Medline].

  27. van den Hoogen BG, de Jong JC, Groen J, et al. A newly discovered human pneumovirus isolated from young children with respiratory tract disease. Nat Med. 2001 Jun. 7(6):719-24. [Medline].

  28. Bosis S, Esposito S, Niesters HG, Crovari P, Osterhaus AD, Principi N. Impact of human metapneumovirus in childhood: comparison with respiratory syncytial virus and influenza viruses. J Med Virol. 2005 Jan. 75(1):101-4. [Medline].

  29. Caracciolo S, Minini C, Colombrita D, Rossi D, Miglietti N, Vettore E. Human metapneumovirus infection in young children hospitalized with acute respiratory tract disease: virologic and clinical features. Pediatr Infect Dis J. 2008 May. 27(5):406-12. [Medline].

  30. Risnes KR, Radtke A, Nordbø SA, Grammeltvedt AT, Døllner H. [Human metapneumovirus--occurrence and clinical significance]. Tidsskr Nor Laegeforen. 2005 Oct 20. 125(20):2769-72. [Medline].

  31. Werno AM, Anderson TP, Jennings LC, Jackson PM, Murdoch DR. Human metapneumovirus in children with bronchiolitis or pneumonia in New Zealand. J Paediatr Child Health. 2004 Sep-Oct. 40(9-10):549-51. [Medline].

  32. van den Hoogen BG, Osterhaus DM, Fouchier RA. Clinical impact and diagnosis of human metapneumovirus infection. Pediatr Infect Dis J. 2004 Jan. 23(1 Suppl):S25-32. [Medline].

  33. Garcia-Garcia ML, Calvo C, Casas I, et al. Human metapneumovirus bronchiolitis in infancy is an important risk factor for asthma at age 5. Pediatr Pulmonol. 2007 May. 42(5):458-64. [Medline].

  34. Dollner H, Risnes K, Radtke A, Nordbo SA. Outbreak of human metapneumovirus infection in norwegian children. Pediatr Infect Dis J. 2004 May. 23(5):436-40. [Medline].

  35. Garcia Garcia ML, Calvo Rey C, Martin del Valle F, et al. [Respiratory infections due to metapneumovirus in hospitalized infants]. An Pediatr (Barc). 2004 Sep. 61(3):213-8. [Medline].

  36. McNamara PS, Flanagan BF, Smyth RL, Hart CA. Impact of human metapneumovirus and respiratory syncytial virus co-infection in severe bronchiolitis. Pediatr Pulmonol. 2007 Aug. 42(8):740-3. [Medline].

  37. Semple MG, Cowell A, Dove W, et al. Dual infection of infants by human metapneumovirus and human respiratory syncytial virus is strongly associated with severe bronchiolitis. J Infect Dis. 2005 Feb 1. 191(3):382-6. [Medline].

  38. Serafino RL, Gurgel RQ, Dove W, Hart CA, Cuevas LE. Respiratory syncytial virus and metapneumovirus in children over two seasons with a high incidence of respiratory infections in Brazil. Ann Trop Paediatr. 2004 Sep. 24(3):213-7. [Medline].

  39. Arnold JC, Singh KK, Spector SA, Sawyer MH. Human bocavirus: prevalence and clinical spectrum at a children's hospital. Clin Infect Dis. 2006 Aug 1. 43(3):283-8. [Medline].

  40. Shaw KN, Bell LM, Sherman NH. Outpatient assessment of infants with bronchiolitis. Am J Dis Child. 1991. 145:151-5. [Medline].

  41. Meissner HC. Selected populations at increased risk from respiratory syncytial viral infection. Pediatric Infectious Disease. 2003. 22:S40.

  42. Wang EE, Law BJ, Stephens D. Pediatric Investigators Collaborative Network on Infections in Canada (PICNIC) prospective study of risk factors and outcomes in patients hospitalized with respiratory syncytial virus lower respiratory tract infections. J Pediatrics. 1995. 126:212-19.

  43. Bloemers BL. Down syndrome: A novel risk factor for respiratory syncytial virus bronchiolitis-a prospective birth-cohort study. Pediatr. Oct 2007. 120:e1076-81.

  44. Horn SD, Smout RJ. Effect of prematurity on respiratory syncytial virus hospital resource use and outcomes. J Pediatr. 2003 Nov. 143(5 Suppl):S133-41. [Medline].

  45. Glezen WP, Paredes A, Allison JE, et al. Risk of respiratory syncytial virus infection for infants from low- income families in relationship to age, sex, ethnic group, and maternal antibody level. J Pediatr. 1981 May. 98(5):708-15. [Medline].

  46. Carroll KN, Gebretsadik T, Griffin MR, et al. Maternal asthma and maternal smoking are associated with increased risk of bronchiolitis during infancy. Pediatrics. 2007 Jun. 119(6):1104-12. [Medline].

  47. Feltes TF, Cabalka AK, Meissner HC, et al. Palivizumab prophylaxis reduces hospitalization due to respiratory syncytial virus in young children with hemodynamically significant congenital heart disease. J Pediatr. 2003 Oct. 143(4):532-40. [Medline].

  48. Duppenthaler A, Ammann RA, Gorgievski-Hrisoho M, Pfammatter JP, Aebi C. Low incidence of respiratory syncytial virus hospitalisations in haemodynamically significant congenital heart disease. Arch Dis Child. 2004 Oct. 89(10):961-5. [Medline].

  49. Papoff P, Moretti C, Cangiano G, et al. Incidence and predisposing factors for severe disease in previously healthy term infants experiencing their first episode of bronchiolitis. Acta Paediatr. 2011 Jul. 100(7):e17-23. [Medline].

  50. Carlsen KH, Orstavik I, Halvorsen K. Viral infections of the respiratory tract in hospitalized children. Acta Pediatr Scand. 1983. 72:53-54.

  51. Henderson FW, Clyde WA Jr, Collier AM, Denny FW, Senior RJ, Sheaffer CI. The etiologic and epidemiologic spectrum of bronchiolitis in pediatric practice. J Pediatr. 1979 Aug. 95(2):183-90. [Medline].

  52. Denny FW, Clyde WA. Acuet lower respiratory tract infections in non-hospitalized children. J Pediatr. 1986. 108:635-646.

  53. La Via WV, Marks MI, Stutman HR. Respiratory syncytial virus puzzle: clinical features, pathophysiology, treatment, and prevention. J Pediatr. 1992 Oct. 121(4):503-10. [Medline].

  54. Shay DK, Holman RC, Newman RD, Liu LL, Stout JW, Anderson LJ. Bronchiolitis-associated hospitalizations among US children, 1980-1996. JAMA. 1999 Oct 20. 282(15):1440-6. [Medline].

  55. Stockman LJ, Curns AT, Anderson LJ, Fischer-Langley G. Respiratory syncytial virus-associated hospitalizations among infants and young children in the United States, 1997-2006. Pediatr Infect Dis J. 2012 Jan. 31(1):5-9. [Medline].

  56. Baldwin RL, Green JW, Shaw JL, Simpson DD, Bird TM, Cleves MA, et al. Physician risk attitudes and hospitalization of infants with bronchiolitis. Acad Emerg Med. 2005 Feb. 12(2):142-6. [Medline].

  57. Stang P, Brandenburg N, Carter B. The economic burden of respiratory syncytial virus-associated bronchiolitis hospitalizations. Arch Pediatr Adolesc Med. 2001 Jan. 155(1):95-6. [Medline].

  58. Brief report: respiratory syncytial virus activity--United States, 2005-2006. MMWR Morb Mortal Wkly Rep. 2006 Dec 1. 55(47):1277-9. [Medline].

  59. Halstead DC, Jenkins SG. Continuous non-seasonal epidemic of respiratory syncytial virus infection in the southeast United States. South Med J. 1998 May. 91(5):433-6. [Medline].

  60. Panozzo CA, Fowlkes AL, Anderson LJ. Variation in timing of respiratory syncytial virus outbreaks: lessons from national surveillance. Pediatr Infect Dis J. 2007 Nov. 26(11 Suppl):S41-5. [Medline].

  61. Hall CB, Geiman JM, Biggar R, Kotok DI, Hogan PM, Douglas GR Jr. Respiratory syncytial virus infections within families. N Engl J Med. 1976 Feb 19. 294(8):414-9. [Medline].

  62. Hall CB, Douglas RG Jr, Geiman JM, Messner MK. Nosocomial respiratory syncytial virus infections. N Engl J Med. 1975 Dec 25. 293(26):1343-6. [Medline].

  63. Leclair JM, Freeman J, Sullivan BF, Crowley CM, Goldmann DA. Prevention of nosocomial respiratory syncytial virus infections through compliance with glove and gown isolation precautions. N Engl J Med. 1987 Aug 6. 317(6):329-34. [Medline].

  64. Isaacs D, Dickson H, O'Callaghan C, Sheaves R, Winter A, Moxon ER. Handwashing and cohorting in prevention of hospital acquired infections with respiratory syncytial virus. Arch Dis Child. 1991 Feb. 66(2):227-31. [Medline].

  65. Rudan I, Tomaskovic L, Boschi-Pinto C, Campbell H. Global estimate of the incidence of clinical pneumonia among children under five years of age. Bull World Health Organ. 2004 Dec. 82(12):895-903. [Medline]. [Full Text].

  66. Weber MW, Mulholland EK, Greenwood BM. Respiratory syncytial virus infection in tropical and developing countries. Trop Med Int Health. 1998 Apr. 3(4):268-80. [Medline].

  67. Koehoorn M, Karr CJ, Demers PA, Lencar C, Tamburic L, Brauer M. Descriptive epidemiological features of bronchiolitis in a population-based cohort. Pediatrics. 2008 Dec. 122(6):1196-203. [Medline].

  68. Terrosi C, Di Genova G, Martorelli B, Valentini M, Cusi MG. Humoral immunity to respiratory syncytial virus in young and elderly adults. Epidemiol Infect. 2009 Dec. 137(12):1684-6. [Medline].

  69. Falsey AR, Hennessey PA, Formica MA, Cox C, Walsh EE. Respiratory syncytial virus infection in elderly and high-risk adults. N Engl J Med. 2005 Apr 28. 352(17):1749-59. [Medline].

  70. Ebbert JO, Limper AH. Respiratory syncytial virus pneumonitis in immunocompromised adults: clinical features and outcome. Respiration. 2005 May-Jun. 72(3):263-9. [Medline].

  71. Iwane MK, Edwards KM, Szilagyi PG, Walker FJ, Griffin MR, Weinberg GA. Population-based surveillance for hospitalizations associated with respiratory syncytial virus, influenza virus, and parainfluenza viruses among young children. Pediatrics. 2004 Jun. 113(6):1758-64. [Medline].

  72. Mage DT, Donner EM. The fifty percent male excess of infant respiratory mortality. Acta Paediatr. 2004 Sep. 93(9):1210-5. [Medline].

  73. Bradley JP, Bacharier LB, Bonfiglio J, Schechtman KB, Strunk R, Storch G, et al. Severity of respiratory syncytial virus bronchiolitis is affected by cigarette smoke exposure and atopy. Pediatrics. 2005 Jan. 115(1):e7-14. [Medline].

  74. La Via WV, Grant SW, Stutman HR, Marks MI. Clinical profile of pediatric patients hospitalized with respiratory syncytial virus infection. Clin Pediatr (Phila). 1993 Aug. 32(8):450-4. [Medline].

  75. Welliver RC, Wong DT, Sun M, Middleton E Jr, Vaughan RS, Ogra PL. The development of respiratory syncytial virus-specific IgE and the release of histamine in nasopharyngeal secretions after infection. N Engl J Med. 1981 Oct 8. 305(15):841-6. [Medline].

  76. Hall CB, Weinberg GA, Iwane MK, et al. The burden of respiratory syncytial virus infection in young children. N Engl J Med. 2009 Feb 5. 360(6):588-98. [Medline].

  77. Brooks M. Suctioning impacts hospital stay in infants with bronchiolitis. Medscape Medical News. March 4, 2013. Available at http://www.medscape.com/viewarticle/780246. Accessed: March 26, 2013.

  78. Mussman GM, Parker MW, Statile A, Sucharew H, Brady PW. Suctioning and Length of Stay in Infants Hospitalized With Bronchiolitis. JAMA Pediatr. 2013 Mar 4. 1-8. [Medline].

  79. Holman RC, Shay DK, Curns AT, Lingappa JR, Anderson LJ. Risk factors for bronchiolitis-associated deaths among infants in the United States. Pediatr Infect Dis J. 2003 Jun. 22(6):483-90. [Medline].

  80. Thorburn K. Pre-existing disease is associated with a significantly higher risk of death in severe respiratory syncytial virus infection. Arch Dis Child. 2009 Feb. 94(2):99-103. [Medline].

  81. Goetghebuer T, Isles K, Moore C, Thomson A, Kwiatkowski D, Hull J. Genetic predisposition to wheeze following respiratory syncytial virus bronchiolitis. Clin Exp Allergy. 2004 May. 34(5):801-3. [Medline].

  82. Stein RT, Sherrill D, Morgan WJ, et al. Respiratory syncytial virus in early life and risk of wheeze and allergy by age 13 years. Lancet. 1999 Aug 14. 354(9178):541-5. [Medline].

  83. Krilov LR, Mandel FS, Barone SR, Fagin JC. Follow-up of children with respiratory syncytial virus bronchiolitis in 1986 and 1987: potential effect of ribavirin on long term pulmonary function. The Bronchiolitis Study Group. Pediatr Infect Dis J. 1997 Mar. 16(3):273-6. [Medline].

  84. Kuppermann N, Bank DE, Walton EA, Senac MO Jr, McCaslin I. Risks for bacteremia and urinary tract infections in young febrile children with bronchiolitis. Arch Pediatr Adolesc Med. 1997 Dec. 151(12):1207-14. [Medline].

  85. Titus MO, Wright SW. Prevalence of serious bacterial infections in febrile infants with respiratory syncytial virus infection. Pediatrics. 2003 Aug. 112(2):282-4. [Medline].

  86. Levine DA, Platt SL, Dayan PS, Macias CG, Zorc JJ, Krief W, et al. Risk of serious bacterial infection in young febrile infants with respiratory syncytial virus infections. Pediatrics. 2004 Jun. 113(6):1728-34. [Medline].

  87. Purcell K, Fergie J. Concurrent serious bacterial infections in 2396 infants and children hospitalized with respiratory syncytial virus lower respiratory tract infections. Arch Pediatr Adolesc Med. 2002 Apr. 156(4):322-4. [Medline].

  88. Greenes DS, Harper MB. Low risk of bacteremia in febrile children with recognizable viral syndromes. Pediatr Infect Dis J. 1999 Mar. 18(3):258-61. [Medline].

  89. Becker S, Soukup J, Yankaskas JR. Respiratory syncytial virus infection of human primary nasal and bronchial epithelial cell cultures and bronchoalveolar macrophages. Am J Respir Cell Mol Biol. 1992 Apr. 6(4):369-74. [Medline].

  90. Ralston S, Hill V. Incidence of apnea in infants hospitalized with respiratory syncytial virus bronchiolitis: a systematic review. J Pediatr. 2009 Nov. 155(5):728-33. [Medline].

  91. Willwerth BM, Harper MB, Greenes DS. Identifying hospitalized infants who have bronchiolitis and are at high risk for apnea. Ann Emerg Med. 2006 Oct. 48(4):441-7. [Medline].

  92. Abreu e Silva FA, Brezinova V, Simpson H. Sleep apnoea in acute bronchiolitis. Arch Dis Child. 1982 Jun. 57(6):467-72. [Medline].

  93. Al-balkhi A, Klonin H, Marinaki K, Southall DP, Thomas DA, Jones P. Review of treatment of bronchiolitis related apnoea in two centres. Arch Dis Child. 2005 Mar. 90(3):288-91. [Medline].

  94. Bruhn FW, Mokrohisky ST, McIntosh K. Apnea associated with respiratory syncytial virus infection in young infants. J Pediatr. 1977 Mar. 90(3):382-6. [Medline].

  95. Church NR, Anas NG, Hall CB, Brooks JG. Respiratory syncytial virus-related apnea in infants. Demographics and outcome. Am J Dis Child. 1984 Mar. 138(3):247-50. [Medline].

  96. Kneyber MC, Brandenburg AH, de Groot R, Joosten KF, Rothbarth PH, Ott A. Risk factors for respiratory syncytial virus associated apnoea. Eur J Pediatr. 1998 Apr. 157(4):331-5. [Medline].

  97. Thomas JA, Raroque S, Scott WA, Toro-Figueroa LO, Levin DL. Successful treatment of severe dysrhythmias in infants with respiratory syncytial virus infections: two cases and a literature review. Crit Care Med. 1997 May. 25(5):880-6. [Medline].

  98. Rivers RP, Forsling ML, Olver RP. Inappropriate secretion of antidiuretic hormone in infants with respiratory infections. Arch Dis Child. 1981 May. 56(5):358-63. [Medline].

  99. Stretton M, Ajizian SJ, Mitchell I, Newth CJ. Intensive care course and outcome of patients infected with respiratory syncytial virus. Pediatr Pulmonol. 1992 Jul. 13(3):143-50. [Medline].

  100. Piastra M, Caresta E, Tempera A, Langer A, Zorzi G, Pulitano S. Sharing features of uncommon respiratory syncytial virus complications in infants. Pediatr Emerg Care. 2006 Aug. 22(8):574-8. [Medline].

  101. Hyvarinen MK, Kotaniemi-Syrjanen A, Reijonen TM, Korhonen K, Korppi MO. Lung function and bronchial hyper-responsiveness 11 years after hospitalization for bronchiolitis. Acta Paediatr. 2007 Oct. 96(10):1464-9. [Medline].

  102. Fjaerli HO, Farstad T, Rod G, Ufert GK, Gulbrandsen P, Nakstad B. Acute bronchiolitis in infancy as risk factor for wheezing and reduced pulmonary function by seven years in Akershus County, Norway. BMC Pediatr. 2005. 5:31. [Medline].

  103. Piippo-Savolainen E, Korppi M. Wheezy babies--wheezy adults? Review on long-term outcome until adulthood after early childhood wheezing. Acta Paediatr. 2008 Jan. 97(1):5-11. [Medline].

  104. Openshaw PJ, Dean GS, Culley FJ. Links between respiratory syncytial virus bronchiolitis and childhood asthma: clinical and research approaches. Pediatr Infect Dis J. 2003 Feb. 22(2 Suppl):S58-64; discussion S64-5. [Medline].

  105. Sweetman LL, Ng YT, Butler IJ, Bodensteiner JB. Neurologic complications associated with respiratory syncytial virus. Pediatr Neurol. 2005 May. 32(5):307-10. [Medline].

  106. Saijo M, Ishii T, Kokubo M, Murono K, Takimoto M, Fujita K. White blood cell count, C-reactive protein and erythrocyte sedimentation rate in respiratory syncytial virus infection of the lower respiratory tract. Acta Paediatr Jpn. 1996 Dec. 38(6):596-600. [Medline].

  107. Vieira RA, Diniz EM, Vaz FA. Clinical and laboratory study of newborns with lower respiratory tract infection due to respiratory viruses. J Matern Fetal Neonatal Med. 2003 May. 13(5):341-50. [Medline].

  108. Liebelt EL, Qi K, Harvey K. Diagnostic testing for serious bacterial infections in infants aged 90 days or younger with bronchiolitis. Arch Pediatr Adolesc Med. 1999 May. 153(5):525-30. [Medline].

  109. Antonow JA, Hansen K, McKinstry CA, Byington CL. Sepsis evaluations in hospitalized infants with bronchiolitis. Pediatr Infect Dis J. 1998 Mar. 17(3):231-6. [Medline].

  110. Bloomfield P, Dalton D, Karleka A, Kesson A, Duncan G, Isaacs D. Bacteraemia and antibiotic use in respiratory syncytial virus infections. Arch Dis Child. 2004 Apr. 89(4):363-7. [Medline]. [Full Text].

  111. Macfarlane P, Denham J, Assous J, Hughes C. RSV testing in bronchiolitis: which nasal sampling method is best?. Arch Dis Child. 2005 Jun. 90(6):634-5. [Medline].

  112. Huguenin A, Moutte L, Renois F, et al. Broad respiratory virus detection in infants hospitalized for bronchiolitis by use of a multiplex RT-PCR DNA microarray system. J Med Virol. 2012 Jun. 84(6):979-85. [Medline].

  113. Casiano-Colon AE, Hulbert BB, Mayer TK, Walsh EE, Falsey AR. Lack of sensitivity of rapid antigen tests for the diagnosis of respiratory syncytial virus infection in adults. J Clin Virol. 2003 Oct. 28(2):169-74. [Medline].

  114. Falsey AR, McCann RM, Hall WJ, Criddle MM. Evaluation of four methods for the diagnosis of respiratory syncytial virus infection in older adults. J Am Geriatr Soc. 1996 Jan. 44(1):71-3. [Medline].

  115. Mallory MD, Shay DK, Garrett J, Bordley WC. Bronchiolitis management preferences and the influence of pulse oximetry and respiratory rate on the decision to admit. Pediatrics. 2003 Jan. 111(1):e45-51. [Medline].

  116. McCulloh R, Koster M, Ralston S, Johnson M, Hill V, Koehn K, et al. Use of Intermittent vs Continuous Pulse Oximetry for Nonhypoxemic Infants and Young Children Hospitalized for Bronchiolitis: A Randomized Clinical Trial. JAMA Pediatr. 2015 Aug 31. [Medline].

  117. Brown, T. Pediatric Bronchiolitis: Intermittent Pulse Oximetry OK. Medscape Medical News. Available at http://www.medscape.com/viewarticle/850335. September 01, 2015; Accessed: September 02, 2015.

  118. Principi T, Coates AL, Parkin PC, Stephens D, DaSilva Z, Schuh S. Effect of Oxygen Desaturations on Subsequent Medical Visits in Infants Discharged From the Emergency Department With Bronchiolitis. JAMA Pediatr. 2016 Feb 29. [Medline].

  119. Henderson D. Oximetry Fails to Predict Future Bronchiolitis Care. Oximetry Fails to Predict Future Bronchiolitis Care. Available at http://www.medscape.com/viewarticle/860282. March 11, 2016; Accessed: May 16, 2016.

  120. Dawson KP, Long A, Kennedy J, Mogridge N. The chest radiograph in acute bronchiolitis. J Paediatr Child Health. 1990 Aug. 26(4):209-11. [Medline].

  121. Schuh S, Lalani A, Allen U, Manson D, Babyn P, Stephens D. Evaluation of the utility of radiography in acute bronchiolitis. J Pediatr. 2007 Apr. 150(4):429-33. [Medline].

  122. Leer JA Jr, Green JL, Heimlich EM, Hyde JS, Moffet HL, Young GA. Corticosteroid treatment in bronchiolitis. A controlled, collaborative study in 297 infants and children. Am J Dis Child. 1969 May. 117(5):495-503. [Medline].

  123. Kellner JD, Ohlsson A, Gadomski AM, Wang EE. Efficacy of bronchodilator therapy in bronchiolitis. A meta-analysis. Arch Pediatr Adolesc Med. 1996 Nov. 150(11):1166-72. [Medline].

  124. Flores G, Horwitz RI. Efficacy of beta2-agonists in bronchiolitis: a reappraisal and meta-analysis. Pediatrics. 1997 Aug. 100(2 Pt 1):233-9. [Medline].

  125. Dobson JV, Stephens-Groff SM, McMahon SR, Stemmler MM, Brallier SL, Bay C. The use of albuterol in hospitalized infants with bronchiolitis. Pediatrics. 1998 Mar. 101(3 Pt 1):361-8. [Medline].

  126. Prendiville A, Green S, Silverman M. Ipratropium bromide and airways function in wheezy infants. Arch Dis Child. 1987 Apr. 62(4):397-400. [Medline].

  127. Everard ML, Bara A, Kurian M, Elliott TM, Ducharme F, Mayowe V. Anticholinergic drugs for wheeze in children under the age of two years. Cochrane Database Syst Rev. 2005 Jul 20. CD001279. [Medline].

  128. Ralston S, Roohi M. A randomized, controlled trial of nasal phenylephrine in infants hospitalized for bronchiolitis. J Pediatr. 2008 Dec. 153(6):795-8. [Medline].

  129. Boogaard R, Hulsmann AR, van Veen L, Vaessen-Verberne AA, Yap YN, Sprij AJ. Recombinant human deoxyribonuclease in infants with respiratory syncytial virus bronchiolitis. Chest. 2007 Mar. 131(3):788-95. [Medline].

  130. Chapman J, Abbott E, Alber DG, Baxter RC, Bithell SK, Henderson EA. RSV604, a novel inhibitor of respiratory syncytial virus replication. Antimicrob Agents Chemother. 2007 Sep. 51(9):3346-53. [Medline].

  131. Chavez-Bueno S, Mejias A, Jafri HS, Ramilo O. Respiratory syncytial virus: old challenges and new approaches. Pediatr Ann. 2005 Jan. 34(1):62-8. [Medline].

  132. Davis IC, Lazarowski ER, Chen FP, Hickman-Davis JM, Sullender WM, Matalon S. Post-infection A77-1726 blocks pathophysiologic sequelae of respiratory syncytial virus infection. Am J Respir Cell Mol Biol. 2007 Oct. 37(4):379-86. [Medline].

  133. Maggon K, Barik S. New drugs and treatment for respiratory syncytial virus. Rev Med Virol. 2004 May-Jun. 14(3):149-68. [Medline].

  134. Johnson DW, Adair C, Brant R, Holmwood J, Mitchell I. Differences in admission rates of children with bronchiolitis by pediatric and general emergency departments. Pediatrics. 2002 Oct. 110(4):e49. [Medline].

  135. Leclerc F, Riou Y, Martinot A, Storme L, Hue V, Flurin V. Inhaled nitric oxide for a severe respiratory syncytial virus infection in an infant with bronchopulmonary dysplasia. Intensive Care Med. 1994 Aug. 20(7):511-2. [Medline].

  136. Langley JM, LeBlanc JC, Wang EE, Law BJ, MacDonald NE, Mitchell I. Nosocomial respiratory syncytial virus infection in Canadian pediatric hospitals: a Pediatric Investigators Collaborative Network on Infections in Canada Study. Pediatrics. 1997 Dec. 100(6):943-6. [Medline].

  137. Christakis DA, Cowan CA, Garrison MM, Molteni R, Marcuse E, Zerr DM. Variation in inpatient diagnostic testing and management of bronchiolitis. Pediatrics. 2005 Apr. 115(4):878-84. [Medline].

  138. Boschert S. Bronchiolitis Care Improves With Peer Networking. Pediatric News. 2012. 46(May):11.

  139. Cincinnati Children's Hospital Medical Center. Evidence based clinical practice guideline for medical management of bronchiolitis in infants less than 1 year of age presenting with a first time episode. National Guideline Clearinghouse. Available at http://guideline.gov/summary/summary.aspx?doc_id=9528. Accessed: February 28, 2010.

  140. Perlstein PH, Kotagal UR, Bolling C, et al. Evaluation of an evidence-based guideline for bronchiolitis. Pediatrics. 1999 Dec. 104(6):1334-41. [Medline].

  141. Perlstein PH, Kotagal UR, Schoettker PJ, Atherton HD, Farrell MK, Gerhardt WE. Sustaining the implementation of an evidence-based guideline for bronchiolitis. Arch Pediatr Adolesc Med. 2000 Oct. 154(10):1001-7. [Medline].

  142. Voets S, van Berlaer G, Hachimi-Idrissi S. Clinical predictors of the severity of bronchiolitis. Eur J Emerg Med. 2006 Jun. 13(3):134-8. [Medline].

  143. McKiernan C, Chua LC, Visintainer PF, Allen H. High flow nasal cannulae therapy in infants with bronchiolitis. J Pediatr. 2010 Apr. 156(4):634-8. [Medline].

  144. Tie SW, Hall GL, Peter S, Vine J, Verheggen M, Pascoe EM, et al. Home oxygen for children with acute bronchiolitis. Arch Dis Child. 2009 Aug. 94(8):641-3. [Medline].

  145. Arnold JH, Hanson JH, Toro-Figuero LO, Gutierrez J, Berens RJ, Anglin DL. Prospective, randomized comparison of high-frequency oscillatory ventilation and conventional mechanical ventilation in pediatric respiratory failure. Crit Care Med. 1994 Oct. 22(10):1530-9. [Medline].

  146. Arensman RM, Statter MB, Bastawrous AL, Madonna MB. Modern treatment modalities for neonatal and pediatric respiratory failure. Am J Surg. 1996 Jul. 172(1):41-7. [Medline].

  147. Beasley JM, Jones SE. Continuous positive airway pressure in bronchiolitis. Br Med J (Clin Res Ed). 1981 Dec 5. 283(6305):1506-8. [Medline].

  148. Gavin R, Anderson B, Percival T. Management of severe bronchiolitis: indications for ventilator support. N Z Med J. 1996 Apr 26. 109(1020):137-9. [Medline].

  149. Khan JY, Kerr SJ, Tometzki A, Tyszczuk L, West J, Sosnowski A. Role of ECMO in the treatment of respiratory syncytial virus bronchiolitis: a collaborative report. Arch Dis Child Fetal Neonatal Ed. 1995 Sep. 73(2):F91-4. [Medline]. [Full Text].

  150. Möller JC, Schaible TF, Reiss I, Artlich A, Gortner L. Treatment of severe non-neonatal ARDS in children with surfactant and nitric oxide in a "pre-ECMO"-situation. Int J Artif Organs. 1995 Oct. 18(10):598-602. [Medline].

  151. Ventre K, Haroon M, Davison C. Surfactant therapy for bronchiolitis in critically ill infants. Cochrane Database Syst Rev. 2006. 3:CD005150. [Medline].

  152. Jat KR, Chawla D. Surfactant therapy for bronchiolitis in critically ill infants. Cochrane Database Syst Rev. 2015 Aug 24. 8:CD009194. [Medline].

  153. Cambonie G, Milesi C, Fournier-Favre S, Counil F, Jaber S, Picaud JC. Clinical effects of heliox administration for acute bronchiolitis in young infants. Chest. 2006 Mar. 129(3):676-82. [Medline].

  154. Hollman G, Shen G, Zeng L, Yngsdal-Krenz R, Perloff W, Zimmerman J. Helium-oxygen improves Clinical Asthma Scores in children with acute bronchiolitis. Crit Care Med. 1998 Oct. 26(10):1731-6. [Medline].

  155. Liet JM, Millotte B, Tucci M, Laflammme S, Hutchison J, Creery D. Noninvasive therapy with helium-oxygen for severe bronchiolitis. J Pediatr. 2005 Dec. 147(6):812-7. [Medline].

  156. Martinon-Torres F, Rodriguez-Nunez A, Martinon-Sanchez JM. Heliox therapy in infants with acute bronchiolitis. Pediatrics. 2002 Jan. 109(1):68-73. [Medline].

  157. Martinon-Torres F, Rodriguez-Nunez A, Martinon-Sanchez JM. Nasal continuous positive airway pressure with heliox in infants with acute bronchiolitis. Respir Med. 2006 Aug. 100(8):1458-62. [Medline].

  158. Martinon-Torres F, Rodriguez-Nunez A, Martinon-Sanchez JM. Nasal continuous positive airway pressure with heliox versus air oxygen in infants with acute bronchiolitis: a crossover study. Pediatrics. 2008 May. 121(5):e1190-5. [Medline].

  159. Paret G, Dekel B, Vardi A, Szeinberg A, Lotan D, Barzilay Z. Heliox in respiratory failure secondary to bronchiolitis: a new therapy. Pediatr Pulmonol. 1996 Nov. 22(5):322-3. [Medline].

  160. Amirav I, Luder AS, Kruger N, Borovitch Y, Babai I, Miron D, et al. A double-blind, placebo-controlled, randomized trial of montelukast for acute bronchiolitis. Pediatrics. 2008 Dec. 122(6):e1249-55. [Medline].

  161. Kellner JD, Ohlsson A, Gadomski AM, Wang EE. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev. 2000. CD001266. [Medline].

  162. Gadomski AM, Brower M. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev. 2010 Dec 8. CD001266. [Medline].

  163. Schuh S, Johnson D, Canny G, Reisman J, Shields M, Kovesi T. Efficacy of adding nebulized ipratropium bromide to nebulized albuterol therapy in acute bronchiolitis. Pediatrics. 1992 Dec. 90(6):920-3. [Medline].

  164. Hammer J, Numa A, Newth CJ. Albuterol responsiveness in infants with respiratory failure caused by respiratory syncytial virus infection. J Pediatr. 1995 Sep. 127(3):485-90. [Medline].

  165. Derish M, Hodge G, Dunn C, Ariagno R. Aerosolized albuterol improves airway reactivity in infants with acute respiratory failure from respiratory syncytial virus. Pediatr Pulmonol. 1998 Jul. 26(1):12-20. [Medline].

  166. Langley JM, Smith MB, LeBlanc JC, Joudrey H, Ojah CR, Pianosi P. Racemic epinephrine compared to salbutamol in hospitalized young children with bronchiolitis; a randomized controlled clinical trial [ISRCTN46561076]. BMC Pediatr. 2005. 5(1):7. [Medline].

  167. Menon K, Sutcliffe T, Klassen TP. A randomized trial comparing the efficacy of epinephrine with salbutamol in the treatment of acute bronchiolitis. J Pediatr. 1995 Jun. 126(6):1004-7. [Medline].

  168. Wainwright C, Altamirano L, Cheney M, Cheney J, Barber S, Price D. A multicenter, randomized, double-blind, controlled trial of nebulized epinephrine in infants with acute bronchiolitis. N Engl J Med. 2003 Jul 3. 349(1):27-35. [Medline].

  169. Lowell DI, Lister G, Von Koss H, McCarthy P. Wheezing in infants: the response to epinephrine. Pediatrics. 1987 Jun. 79(6):939-45. [Medline].

  170. Henderson AJ, Arnott J, Young S, Warshawski T, Landau LI, LeSouef PN. The effect of inhaled adrenaline on lung function of recurrently wheezy infants less than 18 months old. Pediatr Pulmonol. 1995 Jul. 20(1):9-15. [Medline].

  171. Kristjansson S, Lodrup Carlsen KC, Wennergren G, Strannegard IL, Carlsen KH. Nebulised racemic adrenaline in the treatment of acute bronchiolitis in infants and toddlers. Arch Dis Child. 1993 Dec. 69(6):650-4. [Medline].

  172. Ralston S, Hartenberger C, Anaya T, Qualls C, Kelly HW. Randomized, placebo-controlled trial of albuterol and epinephrine at equipotent beta-2 agonist doses in acute bronchiolitis. Pediatr Pulmonol. 2005 Oct. 40(4):292-9. [Medline].

  173. Sanchez I, De Koster J, Powell RE, Wolstein R, Chernick V. Effect of racemic epinephrine and salbutamol on clinical score and pulmonary mechanics in infants with bronchiolitis. J Pediatr. 1993 Jan. 122(1):145-51. [Medline].

  174. Wohl ME, Chernick V. Treatment of acute bronchiolitis. N Engl J Med. 2003 Jul 3. 349(1):82-3. [Medline].

  175. Hartling L, Fernandes RM, Bialy L, Milne A, Johnson D, Plint A, et al. Steroids and bronchodilators for acute bronchiolitis in the first two years of life: systematic review and meta-analysis. BMJ. 2011 Apr 6. 342:d1714. [Medline].

  176. Plint AC, Johnson DW, Patel H, Wiebe N, Correll R, Brant R, et al. Epinephrine and dexamethasone in children with bronchiolitis. N Engl J Med. 2009 May 14. 360(20):2079-89. [Medline].

  177. Livni G, Rachmel A, Marom D, Yaari A, Tirosh N, Ashkenazi S. A randomized, double-blind study examining the comparative efficacies and safety of inhaled epinephrine and nasal decongestant in hospitalized infants with acute bronchiolitis. Pediatr Infect Dis J. 2010 Jan. 29(1):71-3. [Medline].

  178. Reassessment of the indications for ribavirin therapy in respiratory syncytial virus infections. American Academy of Pediatrics Committee on Infectious Diseases. Pediatrics. 1996 Jan. 97(1):137-40. [Medline].

  179. Ventre K, Randolph AG. Ribavirin for respiratory syncytial virus infection of the lower respiratory tract in infants and young children. Cochrane Database Syst Rev. 2007 Jan 24. CD000181. [Medline].

  180. Randolph AG, Wang EE. Ribavirin for respiratory syncytial virus lower respiratory tract infection. A systematic overview. Arch Pediatr Adolesc Med. 1996 Sep. 150(9):942-7. [Medline].

  181. Corneli HM, Zorc JJ, Mahajan P, et al. A multicenter, randomized, controlled trial of dexamethasone for bronchiolitis. N Engl J Med. 2007 Jul 26. 357(4):331-9. [Medline].

  182. Daugbjerg P, Brenøe E, Forchhammer H, Frederiksen B, Glazowski MJ, Ibsen KK. A comparison between nebulized terbutaline, nebulized corticosteroid and systemic corticosteroid for acute wheezing in children up to 18 months of age. Acta Paediatr. 1993 Jun-Jul. 82(6-7):547-51. [Medline].

  183. Davison C, Ventre KM, Luchetti M, Randolph AG. Efficacy of interventions for bronchiolitis in critically ill infants: a systematic review and meta-analysis. Pediatr Crit Care Med. 2004 Sep. 5(5):482-9. [Medline].

  184. De Boeck K, Van der Aa N, Van Lierde S, Corbeel L, Eeckels R. Respiratory syncytial virus bronchiolitis: a double-blind dexamethasone efficacy study. J Pediatr. 1997 Dec. 131(6):919-21. [Medline].

  185. Springer C, Bar-Yishay E, Uwayyed K, Avital A, Vilozni D, Godfrey S. Corticosteroids do not affect the clinical or physiological status of infants with bronchiolitis. Pediatr Pulmonol. 1990. 9(3):181-5. [Medline].

  186. Tal A, Bavilski C, Yohai D, Bearman JE, Gorodischer R, Moses SW. Dexamethasone and salbutamol in the treatment of acute wheezing in infants. Pediatrics. 1983 Jan. 71(1):13-8. [Medline].

  187. Zwerdling RG, O'Sullivan BP. Treatment of bronchiolitis. N Engl J Med. 2003 Oct 2. 349(14):1384-5; author reply 1384-5. [Medline].

  188. Patel H, Platt R, Lozano JM. WITHDRAWN: Glucocorticoids for acute viral bronchiolitis in infants and young children. Cochrane Database Syst Rev. 2008. (1):CD004878. [Medline].

  189. Weinberger MM. High-dose systemic corticosteroids may be effective early in the course of bronchiolitis. Pediatrics. 2007 Apr. 119(4):864-5; discussion 865-6. [Medline].

  190. Sumner A, Coyle D, Mitton C, Johnson DW, Patel H, Klassen TP, et al. Cost-effectiveness of epinephrine and dexamethasone in children with bronchiolitis. Pediatrics. 2010 Oct. 126(4):623-31. [Medline].

  191. Troe JW, Versteegh FG, Mooi-Kokenberg EA, Van den Broeck J. No effect of cromoglycate treatment in hospitalized infants with respiratory syncytial virus bronchiolitis. Pediatr Pulmonol. 2003 Nov. 36(5):455. [Medline].

  192. Bisgaard H. A randomized trial of montelukast in respiratory syncytial virus postbronchiolitis. Am J Respir Crit Care Med. 2003 Feb 1. 167(3):379-83. [Medline].

  193. Sarrell EM, Tal G, Witzling M, Someck E, Houri S, Cohen HA. Nebulized 3% hypertonic saline solution treatment in ambulatory children with viral bronchiolitis decreases symptoms. Chest. 2002 Dec. 122(6):2015-20. [Medline].

  194. Mandelberg A, Tal G, Witzling M, et al. Nebulized 3% hypertonic saline solution treatment in hospitalized infants with viral bronchiolitis. Chest. 2003 Feb. 123(2):481-7. [Medline].

  195. Kuzik BA, Al-Qadhi SA, Kent S, et al. Nebulized hypertonic saline in the treatment of viral bronchiolitis in infants. J Pediatr. 2007 Sep. 151(3):266-70, 270.e1. [Medline].

  196. Al-Ansari K, Sakran M, Davidson BL, El Sayyed R, Mahjoub H, Ibrahim K. Nebulized 5% or 3% hypertonic or 0.9% saline for treating acute bronchiolitis in infants. J Pediatr. 2010 Oct. 157(4):630-4, 634.e1. [Medline].

  197. Brooks CG, Harrison WN, Ralston SL. Association Between Hypertonic Saline and Hospital Length of Stay in Acute Viral Bronchiolitis: A Reanalysis of 2 Meta-analyses. JAMA Pediatr. 2016 Apr 18. [Medline].

  198. Frellick M. Bronchiolitis Reanalysis: Hypertonic Saline Does Not Reduce LOS. Medscape Medical News. Available at http://www.medscape.com/viewarticle/862250. April 20, 2016; Accessed: May 16, 2016.

  199. Perrotta C, Ortiz Z, Roque M. Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old. Cochrane Database Syst Rev. 2005 Apr 18. CD004873. [Medline].

  200. Roqué I Figuls M, Giné-Garriga M, Granados Rugeles C, Perrotta C. Chest physiotherapy for acute bronchiolitis in paediatric patients between 0 and 24 months old. Cochrane Database Syst Rev. 2012 Feb 15. 2:CD004873. [Medline].

  201. Weiss J, Annamalai VR. Discharge criteria for bronchiolitis patients. Pediatrics. 2003 Feb. 111(2):445; author reply 445. [Medline].

  202. Mansbach JM, Clark S, Christopher NC, LoVecchio F, Kunz S, Acholonu U. Prospective multicenter study of bronchiolitis: predicting safe discharges from the emergency department. Pediatrics. 2008 Apr. 121(4):680-8. [Medline].

  203. [Guideline] Brown KK. Chronic cough due to nonbronchiectatic suppurative airway disease (bronchiolitis): ACCP evidence-based clinical practice guidelines. Chest. 2006 Jan. 129(1 Suppl):132S-137S. [Medline].

  204. Norwood A, Mansbach JM, Clark S, Waseem M, Camargo CA Jr. Prospective multicenter study of bronchiolitis: predictors of an unscheduled visit after discharge from the emergency department. Acad Emerg Med. 2010 Apr. 17(4):376-82. [Medline].

  205. Hall CB. Respiratory syncytial virus. Feigin RD, Cherry JD. Textbook of Pediatric Infectious Diseases. Philadelphia, Pa: WB Saunders; 1992. 1653-75.

  206. Hall CB, Douglas RG Jr. Modes of transmission of respiratory syncytial virus. J Pediatr. 1981 Jul. 99(1):100-3. [Medline].

  207. Hall CB, Geiman JM, Douglas RG Jr, Meagher MP. Control of nosocomial respiratory syncytial viral infections. Pediatrics. 1978 Nov. 62(5):728-32. [Medline].

  208. Englund J. In search of a vaccine for respiratory syncytial virus: the saga continues. J Infect Dis. 2005 Apr 1. 191(7):1036-9. [Medline].

  209. Remot A, Roux X, Dubuquoy C, Fix J, Bouet S, Moudjou M, et al. Nucleoprotein nanostructures combined with adjuvants adapted to the neonatal immune context: a candidate mucosal RSV vaccine. PLoS One. 2012. 7(5):e37722. [Medline]. [Full Text].

  210. Groothuis JR, Simoes EA, Levin MJ, et al. Prophylactic administration of respiratory syncytial virus immune globulin to high-risk infants and young children. The Respiratory Syncytial Virus Immune Globulin Study Group. N Engl J Med. 1993 Nov 18. 329(21):1524-30. [Medline].

  211. [Guideline] From the American Academy of Pediatrics: Policy statements--Modified recommendations for use of palivizumab for prevention of respiratory syncytial virus infections. Pediatrics. 2009 Dec. 124(6):1694-701. [Medline].

  212. Palivizumab, a Humanized Respiratory Syncytial Virus Monoclonal Antibody, Reduces Hospitalization From Respiratory Syncytial Virus Infection in High-risk Infants. Pediatrics. 1998 Sep. 102(3):531-7. [Medline].

  213. Romero JR. Palivizumab prophylaxis of respiratory syncytial virus disease from 1998 to 2002: results from four years of palivizumab usage. Pediatr Infect Dis J. 2003 Feb. 22(2 Suppl):S46-54. [Medline].

  214. Prais D, Danino D, Schonfeld T, Amir J. Impact of palivizumab on admission to the ICU for respiratory syncytial virus bronchiolitis: a national survey. Chest. 2005 Oct. 128(4):2765-71. [Medline].

  215. Stevens TP, Hall CB. Controversies in palivizumab use. Pediatr Infect Dis J. 2004 Nov. 23(11):1051-2. [Medline].

  216. Simoes EA, Groothuis JR, Carbonell-Estrany X, Rieger CH, Mitchell I, Fredrick LM. Palivizumab prophylaxis, respiratory syncytial virus, and subsequent recurrent wheezing. J Pediatr. 2007 Jul. 151(1):34-42, 42.e1. [Medline].

  217. Meissner HC, Long SS. Respiratory syncytial virus infection and recurrent wheezing: a complex relationship. J Pediatr. 2007 Jul. 151(1):6-7. [Medline].

  218. Resch B, Gusenleitner W, Nuijten MJ, Lebmeier M, Wittenberg W. Cost-effectiveness of palivizumab against respiratory syncytial viral infection in high-risk children in Austria. Clin Ther. 2008 Apr. 30(4):749-60. [Medline].

  219. Elhassan NO, Sorbero ME, Hall CB, Stevens TP, Dick AW. Cost-effectiveness analysis of palivizumab in premature infants without chronic lung disease. Arch Pediatr Adolesc Med. 2006 Oct. 160(10):1070-6. [Medline].

  220. Carbonell-Estrany X, Simões EA, Dagan R, Hall CB, Harris B, Hultquist M. Motavizumab for prophylaxis of respiratory syncytial virus in high-risk children: a noninferiority trial. Pediatrics. 2010 Jan. 125(1):e35-51. [Medline].

  221. Ozkan H, Atlihan F, Genel F, Targan S, Gunvar T. IgA and/or IgG subclass deficiency in children with recurrent respiratory infections and its relationship with chronic pulmonary damage. J Investig Allergol Clin Immunol. 2005. 15(1):69-74. [Medline].

  222. Emery G. Timing of inhaled adrenaline matters in infant bronchiolitis. Medscape Medical News. June 12, 2013. [Full Text].

  223. Schuh S, Freedman S, Coates A, et al. Effect of oximetry on hospitalization in bronchiolitis: a randomized clinical trial. JAMA. 2014 Aug 20. 312(7):712-8. [Medline].

  224. Skjerven HO, Hunderi JO, Brügmann-Pieper SK, Brun AC, Engen H, Eskedal L, et al. Racemic adrenaline and inhalation strategies in acute bronchiolitis. N Engl J Med. 2013 Jun 13. 368(24):2286-93. [Medline].

  225. Stapleton FB. Reliance on oximetry readings increases hospital admissions for mild-to-moderate bronchiolitis. Journal Watch. August 26, 2014. [Full Text].

 
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A chest radiography revealing lung hyperinflation with a flattened diaphragm and bilateral atelectasis in the right apical and left basal regions in a 16-day-old infant with severe bronchiolitis. Image courtesy of Wikipedia Commons.
Electron micrograph of respiratory syncytial virus (RSV). Image courtesy of Wikipedia Commons.
Airway anatomy showing bronchioles. Image courtesy of Wikipedia Commons.
 
 
 
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