Respiratory Syncytial Virus (RSV)

Respiratory syncytial virus (RSV) is a viral organism that can cause upper and lower respiratory tract infections. It commonly causes bronchiolitis (inflammation of the lower airways) and pneumonia in children and infants under the age of 1.

For most children and infants, RSV infections can be managed on an outpatient basis. However, about 0.5 to 2% of children and infants who develop RSV may require hospitalization.

The disease usually runs its course in one to two weeks. Children who are at risk for developing more severe cases of RSV include the following:

Children / infants younger than 1 year, particularly those between 6 weeks and 6 months

Premature infants

Children / infants with breathing or heart problems

Children / infants with weakened immune systems

How is RSV transmitted?

RSV transmission occurs by coming in contact with infectious material either from another individual or inanimate object. The secretions from the eye, mouth, or nose (and possibly from a sneeze) contain the virus. The virus can also survive for many hours on inanimate objects such as doorknobs, hard surfaces, and toys. It can also live on human hands for up to 30 minutes.

After being exposed to the virus, symptoms may not appear for four to six days. An individual with RSV is usually contagious for three to eight days, although this may be longer in younger children.

What are the symptoms of RSV?

The following are the most common symptoms of RSV infections. However, each child may experience symptoms differently. Symptoms may include:

Lethargy and inactivity

Irritability

Poor feeding

Episodes of apnea (more common in infants; an event where an infant may not take a breath for longer than 10 seconds)

Nasal discharge that is usually clear

Fever

Wheezing (a high-pitched sound usually heard on expiration, breathing out)

Rapid breathing

Cough

Retractions (pulling in) of the chest wall

Nasal flaring

Rattling in the chest that may be felt over an infant's back or chest

The symptoms of RSV may resemble other problems or medical conditions. Always consult your child's physician for a diagnosis.

How is RSV diagnosed?

In addition to a complete medical history and physical examination, other diagnostic tests for RSV may include:

Testing of your child's nasal drainage

Chest X-ray

Pulse oximetry - an oximeter is a small machine that measures the amount of oxygen in the blood. To obtain this measurement, a small sensor (like a band-aid) is taped onto a finger or toe.

How is RSV treated?

There is no cure for RSV, so once the child is infected treatment is supportive (aimed at treating the symptoms present). Care of the child or infant involves treating the effects of the virus on the respiratory system.

Because a virus causes the infection, antibiotics are not useful. Specific treatment for RSV will be determined by your physician based on:

Your child's age, overall health, and medical history

Extent of the condition

Your child's tolerance for specific medications, procedures, or therapies

Expectations for the course of the condition

Your opinion or preference

Treatment for RSV may include:

Keeping your child well hydrated by encouraging fluids by mouth. If necessary, an intravenous (IV) line may be started to give your child fluids and essential electrolytes.

Bronchodilator medications administered in an aerosol mist by a mask or through an inhaler (to open your child's airways)

Supplemental oxygen

Bulb suctioning baby's nose before being laid down to sleep and before feedings, which helps the baby be more comfortable

How is RSV prevented?

Proper handwashing is important to prevent the spread of RSV to other infants, children and adults. If your child is in the hospital, healthcare workers will wear special isolation apparel such as gowns and gloves when they enter your child's room.

Palivizumab, an antibody against RSV, is recommended for babies and children at high risk for RSV to protect them against the serious complications of the illness. This includes children with weakened immune systems, organ recipients and premature infants. Palivizumab is usually given monthly during the RSV "season," from late Fall through Spring. It is not a vaccine and does not prevent the virus.

However, it does lessen the severity of the illness and may help shorten the hospital stay. If you have questions about Palivizumab, please consult your child's physician.

Bronchiolitis

What is bronchiolitis?

Bronchiolitis is a common illness of infants and young children. It occurs during winter and early spring, and affects the entire respiratory tract, including the bronchioles. The bronchioles are the smallest air passages of the lungs.

Bronchiolitis usually begins as a cold, often with symptoms of fever, runny nose or nasal stuffiness, and poor appetite or difficulty with sucking in infants. After 2 to 4 days, the virus spreads to the bronchioles, causing irritation and narrowing of these air passages. This results in a whistling sound (wheeze) when breathing out.

Bronchiolitis is usually mild and the child gets better after 3 or 4 days. However, sometimes the infection is more serious and admission to a hospital is required.

What causes bronchiolitis?

Several different viruses that cause colds and flu-like illnesses can cause bronchiolitis. Respiratory Syncytial Virus (RSV) is the most frequent cause, followed by parainfluenza viruses.

Young children catch these viruses during close contact with older children, family members and others that are infected, but often have only mild illness. The virus is spread directly to mucous membranes when an infected person sneezes or coughs into another's face. It can be spread indirectly by hands that touch contaminated toys or tabletops and then touch the eyes or nose. Illness begins about 3 to 7 days later.

What to expect if your child is hospitalized

Isolation precautions

Because the virus causing bronchiolitis can be spread to others, your child may be put into an isolation room.

The patient room. The door to the room must remain closed. If the room is shared with other patients, parents and visitors should not provide care to the other patients in the room or share equipment or toys.

Hand washing. Everyone going in and out of the room must wash his/her hands. Hands must also be washed after providing direct care to the child; whenever hands are soiled by secretions or excretions; and after touching toys, medical equipment and furniture. Hand washing is the best way to prevent the spread of infection.

Play activities and visitors. Since isolated patients must stay in their bed area, toys and play activities will be provided in your child's room. For the protection of all children, visits are not permitted by brothers, sisters, and friends who are your child's age.

Feeding your baby

Most babies are offered a regular formula or breast milk. Your baby will get plenty of liquids while in the hospital. Liquids are one of the most important things needed by a baby with bronchiolitis.

Sometimes while in the hospital, feedings may be decreased or stopped for a short time. This is done if feeding makes your child breathe harder. Feedings may also be decreased or stopped if your baby starts vomiting. If feedings are decreased or stopped for a short time, liquids may be given through a small needle that is put into a vein.

Suctioning the nose

When babies have bronchiolitis, the nose often gets plugged. This can make it hard to breathe while eating. Often the nose of an infant with bronchiolitis will be suctioned before being fed. Sometimes it is hard to suction mucus out of the nose because it is very thick. When this happens, a little bit of saltwater (saline nose drops) is dropped into the nose before suctioning. While in the hospital, you will want to learn how to use a bulb suction so that you will feel comfortable suctioning your baby's nose after you go home.

Oxygen

Every few hours, or more often, your child's nurse or respiratory therapist will do an assessment of how easily your baby is breathing. This assessment will help decide: 1) if extra oxygen is needed, or 2) if the baby is ready to gradually come off the extra oxygen. The nurse or therapist will teach you how to look for the signs and symptoms of difficult breathing.

A machine called an oximeter may be used with these assessments, but it is not necessary for your child to be connected all the time to this machine.

Laboratory and other tests

Bronchiolitis does not usually require testing, but there are some individual exceptions. These tests include some blood tests and a chest X-ray.

Medicines

Bronchiolitis usually goes away by itself and is not usually helped by giving a lot of medicines, but there are some exceptions. A few medicines may be tried to see if they make your baby feel better. These medicines include:

A non-aspirin fever medicine may be used if your baby is very uncomfortable or has a fever (Remember, never give aspirin to a baby unless instructed by a doctor)

Medicines that your baby can breathe into his/her lungs are sometimes tried and, in some cases, may work in a baby with bronchiolitis

Going home

Discharge from the hospital

Very few babies with bronchiolitis stay in the hospital more than 2-3 days. They usually go home when:

Breathing is slower and easier

They are eating well

Any medicines or oxygen, if still needed, can be given at home

There is someone in the home who can use a nasal bulb suction

Your baby's doctor is comfortable with and agrees to all of the discharge plans

A follow-up appointment with the doctor has been arranged

And, most importantly, you are comfortable that your baby is ready for discharge

What to expect after discharge

It is normal for your child to have symptoms for a few days after discharge (Your family may find they need to take time off work during this initial time to provide extra care for your baby)

Wheezing usually gets better in 2-5 days

Stuffy nose and cough may last another 1-2 weeks

Sleeping and eating routines may not return to normal for 4-7 days

Special reminders

Be sure no one smokes in the house. Smoke can be very bad for babies and especially bad for babies with bronchiolitis.

For the next several weeks, be sure to wash hands frequently especially after handling your infant.

Use saltwater nose drops and suction your baby's nose if stuffy and if plugged up before feedings or putting your baby down to sleep. You can buy saltwater nose drops at any drug store, or you can make saltwater nose drops at home.

Don't give decongestant nose drops or any antihistamines or other cold medicines unless told to do so by the doctor.

For more information talk with your child's doctor or nurse. You can also find very good books on children's illnesses in bookstores or libraries. A librarian can often find exactly what you want. Because it takes a long time to publish books, some books or articles may not have the most recent information. Before worrying about any differences in information, talk with your child's doctor.

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