Bronchiolitis (See Also: Respiratory Syncytial Virus)

Bronchiolitis (See Also: Respiratory Syncytial Virus) is a topic covered in the 5-Minute Pediatric Consult.

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Acute infection of the lower respiratory tract in infants and young children leading to mononuclear infiltration of the bronchiolar epithelium, causing edema and mucus plugging of the small airways


  • Peak season is November through April, with some variation by state in the United States (begins earlier in the Southeast).
  • Most common cause of infant hospitalization
    • ~150,000 hospitalizations per year in the United States
    • Hospitalization rates tripled from 1980 to 1997 with the advent of pulse oximetry but have decreased slightly over the last decade.
  • Most recent estimate ~15 hospitalizations per 1,000 person-years for children <2 years of age
  • Approximately 1/3 of all children will get bronchiolitis in the first 2 years of life.

General Prevention

  • Hand hygiene is the only preventative measure for otherwise healthy infants and children.
  • Palivizumab can be given to high-risk infants and young children (see “Respiratory Syncytial Virus” [RSV] section for discussion of RSV immunoprophylaxis).


  • RSV is the most common causative organism, but other organisms include the following:
    • Human rhinovirus
    • Adenovirus
    • Human metapneumovirus
    • Enterovirus
    • Coronaviruses
    • Influenza viruses
    • Parainfluenza viruses
    • Mycoplasma pneumoniae
    • Human bocavirus
  • Majority of bronchiolitis cases are caused by one virus, but viral coinfections (two or more viruses) may occur in ~1/4 of cases.

Risk Factors

  • Patients at high risk of severe bronchiolitis:
    • Premature infants (<36 weeks’ gestation)
    • Young infants (<2 to 3 months of age)
    • Congenital heart disease
    • Chronic lung disease (including bronchopulmonary dysplasia [BPD])
    • Low birth weight
    • Cystic fibrosis
    • Immunodeficiency
    • Neuromuscular diseases
    • Trisomy 21
  • Exposure to cigarette smoke is a risk factor for more severe disease.

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