Pediatrics provides specialized medical care for infants, children, and adolescents. Learn about routine screenings, vaccinations, and treatments.
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The diagnostic approach to RSV combines clinical acumen with targeted laboratory investigation. Because RSV shares a clinical phenotype with other major respiratory viruses such as influenza, human metapneumovirus, and parainfluenza, distinguishing the etiology is crucial for infection control and prognostic counseling. However, for the otherwise healthy infant with typical bronchiolitis, international guidelines emphasize that diagnosis can often be made on clinical grounds alone to avoid unnecessary testing. At Liv Hospital, the evaluation strategy is risk-stratified: identifying the pathogen in high-risk or hospitalized patients while minimizing invasive procedures in stable outpatients.
In the outpatient setting, the diagnosis of RSV bronchiolitis is primarily clinical. Clinicians evaluate the constellation of symptoms of rhinorrhea, cough, and tachypnea in the context of the season. The physical examination is focused on assessing the severity of respiratory compromise to guide admission decisions.
Pulse oximetry is the “fifth vital sign” in RSV evaluation. It provides a non-invasive measure of oxygen saturation (SpO2). However, clinical guidelines warn against over-reliance on a single number. SpO2 can fluctuate with coughing, sleep, and agitation. Persistent hypoxemia (SpO2 < 90-92%) is a strong indicator for hospitalization. In severe cases, blood gas analysis is performed.
Nucleic Acid Amplification Tests (NAAT), specifically Reverse Transcription Polymerase Chain Reaction (RT-PCR), represent the gold standard for RSV diagnosis. These tests amplify viral genetic material, offering exceptional sensitivity and specificity.
Rapid antigen tests are immunoassays that detect viral proteins in nasopharyngeal secretions. They are widely used in point-of-care settings due to their speed and lower cost compared to PCR.
Routine chest X-rays are discouraged for typical bronchiolitis because the findings often lead to unnecessary antibiotic use. However, imaging is indicated in specific scenarios: severe distress, high fever, asymmetric lung sounds, or worsening clinical course.
Blood work is not routine for uncomplicated RSV, but is used to evaluate systemic toxicity or dehydration.
Urinary tract infections (UTIs) are the most common severe bacterial infection co-occurring with RSV in febrile infants. Because the symptoms of a UTI are non-specific, a catheterized urinalysis and culture are recommended for RSV-positive infants who have high fevers, particularly if they are uncircumcised males or females under 24 months. This ensures that a treatable bacterial infection is not missed under the assumption that the fever is solely due to RSV.
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A healthcare provider inserts a thin, flexible swab gently into the nose, reaching the back of the nasal cavity (nasopharynx). It may be uncomfortable and cause sneezing/tearing, but it is swift.
X-rays usually don’t change the treatment for typical RSV and expose the baby to radiation. Doctors can generally tell what is happening in the lungs by listening with a stethoscope.
No, standard blood tests cannot diagnose RSV. Only a nasal swab can confirm the virus. Blood tests are used to check for dehydration or other infections.
If the rapid test is negative but symptoms strongly suggest RSV, the doctor might send the sample for a more sensitive PCR test to be sure, or they may treat based on symptoms.
Yes, but it is just one piece of the puzzle. Doctors look at how hard the baby is working to breathe, not just the number on the monitor. A baby can have a decent number but still be exhausted.
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