The Expert Consensus on Diagnosis, Treatment and Prevention of Respiratory Tract Syncytial Virus Infection in Children was released!

Respiratory syncytial virus (RSV) is the most important viral pathogen causing acute lower respiratory tract infection (ALRTI) in children under 5 years of age worldwide. RSV infection is the primary factor causing viral respiratory infection in infants. In order to further standardize the diagnosis, treatment and prevention of RSV infection in children, the Expert Consensus on Diagnosis, Treatment and Prevention of Respiratory Tract Syncytial Virus Infection in Children is hereby formulated with reference to the latest research progress of RSV at home and abroad.

General treatment

For children in the acute phase, dynamic observation and assessment of the changes in the condition should be carried out. When the blood oxygen saturation continues to be lower than 90%~92%, oxygen therapy should be given. For severe children, noninvasive continuous positive pressure ventilation (CPAP) or mechanical ventilation and other respiratory support treatments can also be selected. When the upper airway is blocked and causes difficulty in breathing or feeding, sputum suction or nasal drip of 9 g/L saline can be given to relieve the symptoms of nasal congestion and keep the airway smooth.

If the child can eat normally, it is recommended to continue to feed by mouth. In case of shortness of breath, dyspnea, and accidental inhalation caused by choking milk after eating, nutrition can be given through nasogastric tube, and if necessary, intravenous nutrition can be given to ensure the stability of the internal environment of water and electrolyte in the body.

Medication

1. Antiviral drugs

Interferon

For lower respiratory tract infection caused by RSV infection, recombinant human can be used on the basis of conventional treatment such as anti infection, antiasthmatic, oxygen inhalation and rehydration α Interferon was given antiviral treatment. interferon α 1b 2～4 μ G/(kg ? time), twice a day, 5-7 days of treatment; interferon α 2b 100000~200000 IU/(kg ? time), twice a day, 5-7 days of treatment.

Ribavirin

At present, there is no sufficient evidence to prove the effectiveness of ribavirin in the treatment of RSV infection, so it is not recommended to use it routinely.

2 Bronchodilator

Bronchodilators (e.g β 2 receptor agonists) alone or in combination with anticholinergic drugs in children with asthma after RSV infection is still unclear.

For children with RSV infection and wheezing symptoms, bronchodilators can be used, and then the clinical effect can be observed. If the clinical symptoms are relieved after the use of bronchodilators, they can continue to be used; If there is no improvement after medication, consider discontinuing.

For severe children with respiratory failure caused by RSV infection who need ventilator assisted ventilation, bronchodilators may also increase the risk of adverse reactions such as tachycardia, which should be used with caution.

Recommended dosage: salbutamol sulfate solution is inhaled by atomization,<6 years old, 2.5 mg/time, and the interval of administration depends on the severity of the disease. Terbutaline aerosol, body mass<20 kg, 2.5 mg/time. According to the severity of the disease, the drug should be administered 3 to 4 times a day. Isoprotropium bromide, recommended dose:<12 years old, 250 μ G/time, multiple and short-term effects β 2 Receptor agonist (SASB) combined with aerosol inhalation.

3 Glucocorticoid

Routine use of systemic glucocorticoids is not recommended; For asthmatic children with allergic constitution or family history of allergic diseases, aerosol inhalation of glucocorticoid combined with bronchodilators can be used to inhibit airway inflammation, improve ventilation and relieve asthmatic symptoms.

Recommended dose: budesonide 0.5~1.0 mg/time, 1~2 times a day depending on the severity of the disease.

4. Hyperosmotic saline atomization inhalation

The efficacy of 3% hypertonic saline aerosol inhalation in RSV induced lower respiratory tract infection is still controversial, and it is not recommended as a routine drug.

For children with severe dyspnea caused by RSV infection, when other treatments are not effective and the hospitalization lasts for more than 3 days, 3% hypertonic saline can be considered for atomization treatment. The atomization time is required to be less than 20 minutes, and close monitoring is required during the administration. If the clinical symptoms of children with RSV infection do not alleviate, worsen, or have irritating cough for 48 to 72 hours, they need to stop immediately, pay attention to sputum suction, and keep the airway smooth.

Leukotriene receptor antagonist

It is not recommended for routine use. For children with recurrent wheezing after RSV infection, oral administration of leukotriene receptor antagonist can be used to prevent wheezing, and its therapeutic efficacy needs further confirmation.

6 Antimicrobial agents

It is not recommended as routine medication, nor is it recommended as preventive medication; When secondary bacterial infection is considered, or high risk factors of bacterial infection exist in severe cases, anti infection treatment with antibacterial drugs can be applied.

Symptomatic treatment of involvement of other systems outside the respiratory system

On the basis of this treatment, when other system abnormalities are combined, such as pulmonary hypertension, arrhythmia, myocardial damage or even heart failure in the circulatory system, and changes in consciousness such as lethargy, coma or even convulsions in the nervous system, corresponding symptomatic treatment should be actively given.

The above contents are excerpted from: National Clinical Medical Research Center for Respiratory Diseases, Respiratory Group of Pediatric Branch of Chinese Medical Association, Pediatric Respiratory Working Committee of Respiratory Branch of Chinese Medical Association, etc Expert consensus on diagnosis, treatment and prevention of respiratory syncytial virus infection in children [J]. Chinese Journal of Practical Pediatrics, 2020, 35 (04): 241-250

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