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PAUL CHECCHIA, MD, FAAP, FCCM, is Chief, Pediatric Cardiac Critical Care Service and Medical Director, Pediatric Cardiac Intensive Care Unit, St. Louis Children’s Hospital; and Assistant Professor of Pediatric Critical Care and Cardiology, Washington University School of Medicine, One Children’s Place, Northwest Tower 8th floor, St. Louis, MO 63110 (pchecchia{at}wustl.edu).

Purpose. Identifying children at risk for severe respiratory syncytial virus (RSV) so that the most appropriate management strategies can be implemented, thereby reducing the morbidity associated with this disease, is discussed. Summary. RSV infection is associated with a variety of clinical manifestations, ranging from mild cold-like symptoms to more severe disease. The majority of infants infected with RSV develop mild upper respiratory tract disease during their initial RSV infection. However, more severe RSV disease can occur when the lower respiratory tract becomes involved, with symptoms escalating to include significant wheezing and chest-wall retractions, as well as cyanosis and tachypnea in the most severe cases. Extrapulmonary manifestations of RSV disease also have been observed, such as sepsis-like syndrome and arrhythmias. Factors that increase the risk of acquiring RSV infection have been identified, along with factors that increase the risk of severe RSV disease. The American Academy of Pediatrics (AAP) recommends that clinicians assess risk factors for severe disease when making decisions regarding evaluation and management of children with bronchiolitis. There is currently no curative treatment for RSV infection, and management primarily involves the treatment of specific symptoms. The AAP developed clinical practice guidelines to provide an evidence-based approach to the diagnosis and management of bronchiolitis in children aged one month to two years, with detailed recommendations on which therapies are appropriate for children with more severe RSV disease. Conclusion. The AAP developed specific guidelines for the management of RSV bronchiolitis; however, treatment is primarily supportive and has been shown to be suboptimal in many patients. Because of the limitations associated with the management of RSV disease, prevention remains of paramount importance, especially in patients at high risk for severe disease. Index terms: American Academy of Pediatrics; Diagnosis; Pediatrics; Protocols; Respiratory syncytial virus infections