RSV 101: What Every NICU Parent Needs to Know

October 2, 2017

rsv 101, NICU, RSV prevention, baby with nebulizer For most infants, respiratory syncytial (sin-SISH-uhl) virus (RSV) causes an illness like a common cold in the upper and lower respiratory tracts. But some babies, including those born preterm and those with special health care needs, may be at high risk for a severe infection which can cause pneumonia or bronchiolitis, inflammation of the small airways in the lung. These conditions can lead to serious complications, re-hospitalization and in some cases, death. According to the Institute of Allergy and Infectious Diseases, 75,000 to 125,000 children in the United States are admitted to the hospital for RSV infections each year. Fortunately, education about the virus and prevention steps can help you reduce your child’s risk.

Ariel Doggett shares her family’s experience with RSV: “Like most families, RSV hit us unexpectedly. Our son, Will, was born four weeks early, at the tail end of RSV season and didn’t meet the criteria to qualify for Synagis. I was not fully aware of all the dangers of RSV. Will ended up contracting RSV when he was three and a half weeks old. He quickly deteriorated medically and was med-flighted to Children’s Hospital in Boston. He was placed on life support within his first week of hospitalization and as a last resort ended up on a heart-lung bypass system for almost two weeks. During his subsequent three-month ICU stay for RSV he suffered a stroke that left him with a significant visual deficit, right-sided weakness, chronic lung disease, and asthma.

Is Your Baby or Young Child at Risk for RSV?

A preemie may appear healthy, yet still have injured lungs. Chronic Lung Disease (CLD) is the result of a baby’s lungs getting irritated or inflamed. Babies may need a machine called a ventilator to help them breathe. Pressure from a ventilator can sometimes irritate the fragile lungs of these babies, which can cause CLD. CLD may also develop in babies who have received high levels of oxygen for a long time or have had pneumonia. Because their lungs are not normal and may still be healing, babies with CLD are at increased risk for severe RSV disease.

Working with your doctor, you can create a protection plan for your baby. However, it is important to know what the risk factors for premature infants and young children may include:

Young chronological age (≤12 weeks of age) at the start of RSV season.
Being around other children at daycare.
Family history of wheezing or asthma.
Exposure to tobacco smoke and other air pollutants (never allow anyone to smoke around your baby).
Premature or low birth weight due to multiple, twin, and triplet births.
Low birth weight (less than 5.5 pounds).
Crowded living conditions.
Pre-school or school-aged sibling(s).
A congenital heart defect (CHD) or heart condition.
Chronic lung disease like cystic fibrosis.
Weakened immune system due to illness or treatments.
A serious lung infection, repeat doctor visits, and hospitalization depending on the severity of the RSV infection.

How Early Was Your Preemie?

If your baby was born at 28 weeks or earlier they might not have received all the virus-fighting substances, called antibodies, from mom. Also, babies born at 28 weeks may have small, underdeveloped, and narrow airways for breathing thus placing them at high risk for severe RSV disease.

If your baby was born at 29-31 weeks, a critical lung infection could cause clogged airways and dangerous breathing problems that might lead to hospitalization.

If your baby was born at 32-35 weeks and is six months or younger at the start of RSV season, he or she is considered to be at high risk for severe RSV disease.

If your baby was born at 36 weeks or later, most full-term babies get a mild form of RSV disease.

RSV Symptoms and Diagnosis

An RSV infection usually causes moderate-to-severe cold symptoms in the upper and/or lower respiratory tract. In young infants, the symptoms may be less obvious. According to the American Lung Association, “In very young infants, the only symptoms may be irritability, decreased activity, and breathing difficulties.”

Symptoms to Look For:

Coughing, sneezing or wheezing that does not stop
Stuffy or runny nose
Fast breathing or gasping for breath
Spread-out nostrils and/or a caved-in chest when trying to breathe
Bluish color around the mouth or fingernails
Fever (in infants under three months of age, fever greater than 100.4°F rectal is a cause for concern)
Mild sore throat
Lower appetite
Trouble sleeping

For diagnosis, your baby’s physician may test a nasal swab for evidence of the virus. A chest x-ray and/or oxygen saturation test may also be done to check for lung congestion.

RSV Treatment

As with many viruses, once the diagnosis is confirmed treatment is limited to managing symptoms. Less severe cases may receive medicine to reduce fever or medication delivered via a nebulizer, which converts medicine to an easily-inhaled mist assisting the lungs during an infection. Fluids are often recommended, especially for young children and infants, to prevent dehydration. A bulb syringe can be used to suction mucus from nasal airways in infants.

If your child has a severe form of RSV, he or she may need to be hospitalized and treated with oxygen, have mucus suctioned from the airways, or be placed on a ventilator to assist with breathing. Often hospitalization lasts a few days with most children recovering within one to two weeks.

RSV Prevention

prevent RSV hand to hold RSV spreads just like a common-cold virus. According to the CDC, “people infected with RSV are usually contagious for 3 to 8 days. However, some infants and people with weakened immune systems can be contagious for as long as four weeks.” Because contracting RSV does not give protection from future infections, your child can get RSV multiple times – even during a single season. The first infection is usually the most severe with subsequent infections having milder symptoms. Taking a few extra precautions around your family and friends can help protect your baby and young child during RSV season.

Be sure to:

Wash your hands thoroughly before touching your baby, and ask others to do the same.
Cover your coughs or sneezes and show siblings how to practice good hygiene.
Don’t let anyone smoke in your home or near your baby or child.
Wash your baby’s toys, clothing, and bedding often.
Don’t share eating utensils and cups with one another.
Consider regularly disinfecting high-traffic hard surfaces such as door knobs.
Keep your baby away or limit exposure to crowds, young children, and anyone with colds.
Talk to your pediatrician about palivizumab (Synagis®) shots during RSV season.

Preventative Injections

Palivizumab (Synagis®) is the only FDA-approved medication to help protect high-risk babies from severe RSV disease. Even though it is administered as a shot by your healthcare provider, it is not a vaccine. Each shot, which is given monthly during RSV season, provides a dose of virus-fighting substances called antibodies that help prevent severe RSV disease from infecting your baby’s lungs.

“RSV is one viral illness that actually can be prevented with adequate prophylaxis,” said Dr. Sarmistha B. Hauger, Director, Pediatric Infectious Disease, Specially For Children, Dell Children’s Medical Center. “Babies who fit into the high-risk criteria and are born at the time RSV may be circulating in a community should be identified quickly and placed on a regimen of monthly injections of palivizumab (Synagis®). This antibody is extremely effective at preventing serious illness secondary to RSV,” reports Dr. Hauger.

Synagis® helps preemies by providing more infection-fighting antibodies to help protect their vulnerable lungs from RSV. The shots are effective for about a month, which why it’s important to get every single shot on schedule during RSV season.

When is RSV Season?

When it comes to protecting your baby’s growing lungs from RSV, timing is everything. RSV season usually starts in the fall and continues into spring, but the season may be different where you live. Your first step should be talking to your baby’s healthcare provider to find out when RSV season starts and ends in your area. Visit RSV Protection to search for RSV season by state or visit the Centers for Disease Control and Prevention which forecasts RSV season by region. Talk to your pediatrician about how to help protect your preemie based on your area.

Ariel Doggett recounts, “While as his mother I would give almost anything not to have had Will go through all of that, I would not change any of it since it made him the wonderful, happy, loving little boy he is today. I have to wonder, though, if were given preventative protection against RSV could all of it have been avoided? The importance of proactive, preventative inoculation cannot be stressed highly or often enough. You are the best advocate your child has. It is okay to question the doctor and be your child’s voice,” said Doggett.

More on RSV

In this video, Dr. Sarmistha Hauger, pediatric infectious disease specialist at Dell Children’s Medical Center, explains how to prevent exposure to RSV, who is at highest risk and treatments which are available, such as a protective injection (Synagis) that is available. Kasey Mathews, whose daughter was born at 25 weeks and was re-hospitalized at age 2 with RSV shares her story.