Take-away Points

For RSV

• Generally no CXR or RSV testing recommended as routine
• Don't give albuterol or hypertonic saline nebulizers, steroids, antibiotics - just supportive care generally (Ribivirin not great)
• No chest PT or excessive nasal suctioning (but do SOME nasal suctioning)
• Admission for hypoxia with O2 sats <90% or RR>60
• If admitted, don't do continuous sat monitoring - increases LOS without changing outcome
• Synagis (Palivizumab) prophylaxis for susceptible children for 5 months in first RSV season
• Most common concomitant bacterial infection is UTI

For Other Viruses

• They all present very similarly - except adenovirus which presents as pretty much anything or everything
• Pretty much all are seasonal, with Parainfluenza at either end of the Flu/RSV season
• Pretty much all supportive care

Procalcitonin

• Best predictor of Bacteremia and Meningitis in kids 7-90 days - Better than CRP
• Very good marker for serious bacterial infection (UTI or bacterial gastroenteritis)

Vitamin D and Bronchiolitis

• Levels <20 associated with more severe infection and longer LOS
• Of the kids with <20, more breastfed and fewer given the supplemental vitamin D - not really discussed, but is this the failure?
• Should be more proactive about getting breastfed kids on vitamin D supplementation and making sure they stay on it!