• Viral infection 
• Respiratory Syncytial Virus 
• (RSV) (75% of pathogens)
• Rhinoviris
• Adenoviris
• Parainfluenza
• Mycoplasma pneumoniae
• Streptococus
• Epidemiology Diagnosis 

• Diagnosis
• Symptoms
  • rales or wheezes
  • rhinitis
  • fever
  • cough
  • coryza
  • hypoxemia
  • apnea
    • occurs 18 - 20% of hospitalized infants
      • less than 32 weeks gestation
      • neonatal apnea
      • mostly nonobstructive central apnea
      • 10% may need intubation
  • infiltrates on CXR
  • RSV sheddings (7-10 days)
  • hyperinflation
  • feeding difficulties
  • retractions
  • tachypnea
• Risk Factors:
  • nosocomial infection
  • infants less than 6 months age highest mortality
  • infants > 3 years age are much less affected
  • congenital cardiac defects
  • BPD
  • cystic fibrosis
  • asthma
• Pathology
  • Histology
• Radiology
  • hyperinflation
  • 20-30% lobar infultrate vs atelectasis
• Treatment
  • Small Particle Aerosol Generator
  • Bronchodilators
    • Albuterol (questional effect)
    • Heliox (70% helium / 30% Oxygen)
  • Racemicepinethrine (.1 mg/kg Continuous Aresol)
  • Fluid administration
• Prevention
  • Synagis monthly 15mg/kg
  • Colostrum may be of benefit
• Medication
• Role of Respiratory Therapy
  • Mechanical ventilation (usually at least 3 day course)
    • CPAP (effective for most infants)
    • If ventilated use slow rates and short I times
  • Ribavirin administration

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