A 13-day-old full-term girl is brought to the physician during winter with a runny nose, cough, and fussiness over the past 2 days. Her birth history is unremarkable and she has been feeding and growing well. The girl has a sibling in day care, where other children have been ill. Her temperature is 37.8 C (100 F), respirations are 70/min, and pulse oximetry is 95% on room air. Examination shows a crying infant with clear rhinorrhea and bilateral wheezes and crackles. Which of the following complications is this patient at greatest risk of developing?

Question

A 13-day-old full-term girl is brought to the physician during winter with a runny nose, cough, and fussiness over the past 2 days.  Her birth history is unremarkable and she has been feeding and growing well.  The girl has a sibling in day care, where other children have been ill.  Her temperature is 37.8 C (100 F), respirations are 70/min, and pulse oximetry is 95% on room air.  Examination shows a crying infant with clear rhinorrhea and bilateral wheezes and crackles.  Which of the following complications is this patient at greatest risk of developing?

Quizplus · Accepted Answer

11ec25c8_d723_fef8_bc81_17ae9d5d94a8_MD0003_00 Bronchiolitis is a common winter respiratory tract infection caused primarily by respiratory syncytial virus (RSV). In older children, RSV infection is generally a self-limiting, mild, upper respiratory tract infection (eg, nasal congestion, rhinorrhea). However, children age <2 years tend to have lower respiratory tract involvement. The wheezing and/or crackles and respiratory distress can have a waxing/waning course that peaks on days 5-7 of illness. Diagnosis is primarily clinical, and treatment is largely supportive (eg, hydration, saline nasal drops, nasal bulb suction). Palivizumab is a monoclonal antibody against RSV that is used for prophylaxis in children age <2 years who are at exceptionally high risk of complications (Table). Infants age <2 months are at high risk of developing apnea and respiratory failure from bronchiolitis. In addition, they tend to develop recurrent wheezing throughout childhood. (Choices B and C) Bronchiolitis is associated with an increased risk of acute otitis media (up to 10%), but coexisting bacterial pneumonia and sepsis are rare (<1%) unless the patient requires mechanical ventilation in the pediatric intensive care unit. Serious bacterial infection is also unlikely with a temperature < 38 C (100.4 F). (Choice D) Secondary fungal (eg, Aspergillus) infection is an unlikely complication unless the patient has an underlying immunodeficiency. (Choice E) Lymphoma and nasopharyngeal cancer are associated with infection by the Epstein-Barr virus. Malignancies are not associated with RSV. Educational objective: Bronchiolitis is most commonly caused by respiratory syncytial virus and manifests as upper respiratory symptoms, wheezing/crackles, and respiratory distress. Neonates are especially vulnerable to complications such as apnea and respiratory failure. References: Apnea in children hospitalized with bronchiolitis. (http://www.ncbi.nlm.nih.gov/pubmed/24101759) Identifying hospitalized infants who have bronchiolitis and are at high risk for apnea. (http://www.ncbi.nlm.nih.gov/pubmed/16997681) Occult serious bacterial infection in infants younger than 60 to 90 days with bronchiolitis: a systematic review. (http://www.ncbi.nlm.nih.gov/pubmed/21969396) Pulmonary and systemic bacterial co-infections in severe RSV bronchiolitis (http://www.ncbi.nlm.nih.gov/pubmed/15557055) Diagnosis and management of bronchiolitis. (http://www.ncbi.nlm.nih.gov/pubmed/17015575)

A 13-Day-Old Full-Term Girl Is Brought to the Physician During