Presentation
A previously healthy 9-month-old is brought to the ED in mid-December with 3 days of nasal congestion, cough, and low-grade fever, now with worsening work of breathing and reduced feeding (roughly half of normal intake). This is his first-ever episode of wheezing, and several children at his daycare have had colds. He has no personal or family history of asthma or atopy.
Initial observations
- T 38.0°C
- HR 150
- RR 60
- BP 88/54
- SpO2 91% on room air
- weight 9 kg
exam: diffuse bilateral wheezes and fine crackles, mild subcostal retractions, wet cough with copious nasal secretions.
Based on the age, presentation, and exam, which diagnosis is most likely?