VIDA
RSV Clinical PathwaySouth Africa • bedside decision support
Wits VIDA style • clinician tool

RSV & bronchiolitis

Fast clinical support for recognition, severity, acute management, disposition and prevention — designed for use on a phone at the bedside.

🚨 Immediate red flags

Apnoea, central cyanosis, exhaustion, severe respiratory distress, reduced consciousness, convulsions, inability to feed safely, or persistent hypoxaemia require urgent hospital-level assessment.

🩺

Acute assessment

Pattern, physiology, risk and disposition.

💨

Management

Supportive care, oxygen, hydration and what to avoid.

🛡

Prevention

Maternal vaccine, nirsevimab and high-risk pathways.

🏠

Discharge

Readiness checklist and caregiver safety-net.

VIDA SPARK: Systems, Platforms, AI, Research, Knowledge
Step 1 of 5Patient context

Patient context

Age and baseline risk influence severity and the threshold for referral.

Patient details No data is stored
Pathway designed mainly for children under 24 months.
Prematurity is automatically reflected in risk.
Additional high-risk features

Acute management

Bronchiolitis is predominantly supportive. Escalate respiratory support rather than stacking low-value medicines.

🚨 Escalate immediately

Apnoea, central cyanosis, severe distress, exhaustion, persistent hypoxaemia despite oxygen, inability to feed safely, convulsions or reduced consciousness.

  • Use supplemental oxygen when clinically indicated by hypoxaemia and local protocol.
  • Reassess saturation, work of breathing, respiratory effort and trajectory after intervention.
  • If standard oxygen is inadequate, seek senior/PICU input and consider high-flow nasal oxygen or CPAP according to local capability.
  • Apnoea, exhaustion or deteriorating respiratory effort warrants urgent advanced-airway / critical-care assessment.
  • Continue breastfeeding / oral feeds when safe and tolerated.
  • Consider smaller, more frequent feeds.
  • If oral intake is inadequate, NG/OG fluids or feeds can be considered when respiratory status permits.
  • Use isotonic IV fluid if enteral fluids are not tolerated or respiratory failure is impending; reassess and avoid fluid overload.
  • Minimal handling with regular reassessment of respiratory effort, oxygenation, feeding, hydration and mental status.
  • Clear obstructing upper-airway secretions when they are interfering with feeding or breathing; avoid routine aggressive suction.
  • Use hand hygiene, respiratory etiquette and facility infection-prevention measures.
  • Bronchodilators in definite bronchiolitis. If recurrent wheeze / atopy makes asthma plausible, manage that diagnostic uncertainty explicitly.
  • Corticosteroids.
  • Antibiotics unless bacterial infection is suspected or confirmed.
  • Routine chest X-ray and routine blood investigations in uncomplicated typical disease.
  • Focal signs / high fever: consider pneumonia or another focal process.
  • Recurrent episodic wheeze / atopy: consider viral-induced wheeze or asthma.
  • Stridor / barking cough: consider upper-airway disease.
  • Sudden onset / choking: consider foreign-body aspiration.
Step 1 of 4Choose pathway

RSV prevention chooser

Start with who you are seeing now.

Current patient
Principle: maternal vaccination protects through transplacental antibody; nirsevimab gives the infant direct passive protection. One primary strategy is generally used for the mother–infant pair, with selected exceptions.

Discharge & safety-net

Use this as a final bedside check. Clinical judgement and reliable follow-up remain essential.

Before discharge
✓Respiratory effort is stable or improving and there is no apnoea, exhaustion, cyanosis or concerning deterioration.
✓Oxygenation is acceptable on room air according to the child’s clinical context and local protocol.
✓The infant can feed safely enough to maintain hydration.
✓Caregiver understands expected course and when to return urgently.
✓Home circumstances, distance and ability to return for care are acceptable.
Return urgently for
🚨Breathing worsens: marked recession, grunting, pauses/apnoea, blue colour, or the child appears exhausted.
🍼Feeding deteriorates: unable to feed, persistent vomiting, significantly fewer wet nappies, or dehydration concerns.
😴Behaviour changes: unusually sleepy, difficult to wake, reduced responsiveness, or convulsions.
❤️Caregiver concern: return earlier whenever the caregiver feels the child is getting worse.
At home
  • Continue breastfeeding and frequent small feeds if tolerated.
  • Gentle saline / suction only when secretions are interfering with feeding or breathing.
  • Reduce cigarette and biomass-smoke exposure where possible.
  • Hand hygiene and avoiding close contact with symptomatic people reduce transmission.
  • Review RSV prevention eligibility after recovery when relevant.

Evidence & app information

Sources underpinning the current pathway. Open links when internet access is available.

South African Standard Treatment Guidelines & Essential Medicines List — Paediatrics

Clinical bronchiolitis assessment, severe features and supportive management principles.

NICD — RSV surveillance and South African seasonality

Use current NICD surveillance rather than assuming a fixed RSV calendar.

Open NICD ↗
WHO — RSV immunisation products

Maternal RSV vaccination and long-acting monoclonal antibody implementation principles.

Open WHO ↗
SAHPRA professional information

Confirm the latest registered indications, gestational window, dosing and product-specific precautions before use.

Open SAHPRA ↗
Clinical-use disclaimer: This educational decision-support tool is not a substitute for clinician assessment, current South African STGs, local institutional policy, SAHPRA-approved professional information, or specialist advice. It intentionally stores no patient information in local storage and sends no clinical data to a server. Mobile build: 26 October 2026.
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