First, influenza virus, adenovirus, hMPV, PIV, RV, and RSV can all cause bronchiolitis, necessitating hospitalization. A few examples of primary immunodeficiency disorders that may be associated with recurrent respiratory infections include: If you and your pediatrician believe that your child might possibly have an underlying reason for recurrent respiratory infections, a thorough history and physical exam as well as additional testing is often done. They most commonly present between the ages of 6 months and 2 years—after maternal antibodies are no longer present. This should include a detailed account of infections in the past, including the severity and treatments used. For Primary Immunodeficiency Diseases, 5th Edition, Montella S, Corcione A, Santamaria F, et al. Supportive Treatment and Inhalation of Hypertonic SalineGiven the lack of effective medications, current treatment for severe viral LRTI in infants relies on supportive measures only. Congenital abnormalities of the upper or lower airways, such as bronchial hypoplasia or bronchial stenosis, Foreign body in the airways (either in the nasal/sinus passages or bronchial tree), Abnormalities of the head/face (craniofacial abnormalities), Ciliary dyskinesis or immotile cilia syndrome: When the tiny hairs that line the airways do not function properly to remove debri from the airways, Neurological conditions that interfere with swallowing (which can lead to aspiration), Infections, such as HIV, Epstein-Barre virus (EBV, the virus that causes "mono"), cytomegalovirus (CMV), Medications, such as corticosteroids (such as prednisone), chemotherapy, Blood-related cancers such as leukemia and lymphoma, Asplenia (lack of a spleen or splenic function), such as with hereditary spherocytosis, sickle cell disease, or children who have had a splenectomy due to trauma, Eight or more ear infections (otitis media) in a one-year period, Two or more sinus infections in 12 months, Two or more episodes of pneumonia in 12 months, Three or more episodes of bronchitis or bronchiolitis, A productive (wet) cough that lasts more than four weeks (a wet cough could be a symptom of bronchiectasis, cystic fibrosis, immunodeficiencies, foreign body aspiration, congenital lung abnormalities, and more), An infection that is persisting despite two months on antibiotics, The need for intravenous antibiotics to resolve an infection, A family history of primary immunodeficiency (most children who have a primary immunodeficiency do not have a family history), A history of alternating diarrhea and constipation combined with repeated respiratory infections (often seen with cystic fibrosis), A history of infections with uncommon organisms, Height and weight: These are extremely important measurements. A Cochrane meta-analysis that included 3 studies that showed some reduction in the duration of mechanical ventilation and in the length of stay in intensive care concluded that there are no sufficiently powered data to provide reliable estimates of surfactant effects on ventilated infants with LRTI (340). Specific treatment is usually neither available nor required. Increased exposure to infectious organisms, such as living or working in a crowded environment or working in a daycare or school with young children 2. Complete blood count (CBC) and differential to look for low levels of white blood cells, red blood cells, or platelets, Serum immunoglobulin levels (IgG, IgA, IgM): Further testing such as IgG subclasses, lymphocyte analyses, complement studies, etc. It will be of great interest to see how this pandemic plays out and what effect it has on strategic health care planning for the future. 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