Respiratory Syncytial Virus (RSV) In Babies – Causes, Symptoms And Treatment

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Respiratory syncytial virus (RSV) is a nasty pathogen responsible for a host of respiratory infections in infants. It primarily targets the lungs and its internal air tubes called bronchioles. Infants are at a higher risk of the infection, and proper care needs to be taken, so they do not get infected.

But how would you know that your baby has an RSV infection? Don’t worry as MomJunction acquaints you with the symptoms, treatment procedures, and the essential ways to shield the baby from the RSV.

What Is RSV?

The human respiratory syncytial virus or RSV attacks the respiratory system, especially the lungs and bronchioles (1). RSV infections cause severe cold, fever, and in some cases pneumonia. It is a tough pathogen and can survive on everyday household items. It is the major cause of bronchiolitis and viral pneumonia in children younger than  one year of age and is the most important respiratory tract pathogen of early childhood.

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How Do Babies Get RSV?

RSV is highly contagious and can spread in the following ways:

  1. Inhaling the virus: Inhalation of mucus droplets expelled by an infected person spreads infection. Infected people must cover their mouth and nose while sneezing and coughing or use a tissue or handkerchief. They should also wash their hands immediately and ensure they are not around the baby.
  1. Physical contact with the virus: The baby contracts the virus when he touches an infected surface like a toy that has been exposed to mucus droplets or touched by an infected person. The virus enters the baby’s body when he puts his hand in his mouth or nose. Infections spread in day care centers, play schools, etc. (2)
  1. Physical contact with infected person: When the baby is kissed or held too close by a person with RSV, the virus transmits to the infant either by air, mucus, or infected body surface.

RSV is robust and can survive for more than 30 minutes on infected hands. It can live for more than five hours on hard surfaces such as baby’s toys (3). Even parents can catch the virus from an RSV-infected baby (4) so cut down on those good night kisses! Some conditions exacerbate the risks of the virus’ transmission.

Certain catalysts make the highly infectious virus becomes even more contagious.

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Conditions That Aggravate The RSV Infection

The likelihood of the baby contracting RSV increases in the following situations:

  • The infant lives in a crowded house.
  • The baby spends a significant time at a daycare center.
  • The little one is exposed to secondhand tobacco smoke as passive smoking increases the susceptibility to RSV infection.

The infection may not be severe in all the infants. Some might have just mild symptoms, while for some it could be difficult to manage.

Who Are At A Greater Risk Of RSV Infection?

Following infant groups are at an increased risk of being affected by RSV:

  1. Premature babies: Preterm infants are the highest risk of developing an RSV infection as they have underdeveloped lungs. A premature baby will also receive fewer in-utero antibodies from the mother than a full-term infant thus lowering immunity and making them vulnerable to viral infections (5).
  1. Younger than six months: Newborns below six months have a nascent immune system, which is not strong enough to fight infections.
  1. Congenital heart problem and chronic lung disease: Congenital heart disease affects the oxygen-carrying capability of the red blood cells. Poor respiration compounds the low blood oxygen levels, causing complications. Babies suffering from chronic lung disease also suffer a similar situation.
    1. Immunodeficiency: A compromised immunity system cannot defend the body from pathogens and reduces its capability to produce antibodies. This intensifies the infection and its effects.

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Are RSV Infections Seasonal?

RSV is distributed worldwide and appears in yearly epidemics. In temperate climates, these epidemics occur each winter over a four to five months period. During the remainder of the year, infections are sporadic and much less common(6).

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What Are The Symptoms Of RSV Infection?

The symptoms of RSV resemble those of common cold:

  1. Runny nose and mild cough are the first symptoms with the cough worsening in a couple of days. It becomes “croupy”, meaning it gets louder and seems like a bark. The infant will also have a sore throat.
  1. The infant will have a fever of 100ºF (38ºC) or more.
  1. The baby breathes quickly, has a shallow breath, and his nostrils flare (widen). The infant has trouble getting enough air to his lungs. Wheezing is a common symptom of bronchiolitis and pneumonia caused by RSV (7) (8).
  1. Lips and fingertips turn bluish because the infant is unable to breathe properly and the blood oxygen levels drop. Poorly oxygenated blood has a bluish-red color, which makes the cells blue (9). The blue color is clearly noticeable on lips and fingertips.
  1. Chest congestion and shortness of breath make swallowing difficult and lead to reduced appetite. A constant headache could compound the lack of interest in food.

The incubation period, which is the time between the onset of the infection and display of symptoms, is four to six days (10). Most infants below two years would have suffered from RSV at least once (11). There could, however, be situations when your baby may need immediate medical attention.

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When To Take An RSV-Infected Baby To The Hospital?

Under the following circumstances, you need to take the baby to a doctor:

  • Very high fever of over 100ºF (38ºC), and the baby’s body is hot.
  • Thick nasal mucus with a tint of green or blood in mucus could indicate severe infection.
  • If the infant is drowsy or semi-conscious, it is a sign of weakness as the baby must be refusing to feed.
  • The baby gasps to breathe due to blocked airways causing extreme trouble in breathing.

The baby will undergo a series of tests at the doctor’s clinic to determine the presence of RSV.

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How Is RSV Diagnosed?

The definitive diagnosis of RSV infection is based on the detection in respiratory secretions of live virus by cell culture. RSV test for infants is conducted through the following procedures:

  1. Mucus test: Samples of mucus collected from the baby’s nose using a cotton swab would be sent for laboratory analysis.
  1. Molecular diagnostic test: The presence of viral RNA (detected by a molecular diagnostic test using reverse transcription PCR) or viral antigens (detected by a rapid diagnostic test, usually a membrane blotting test incorporating antibody detection of viral proteins) is strongly supportive in the right clinical setting.
  1. Chest X-rays: These help the doctor screen the lungs and see if the infant has developed bronchiolitis or pneumonia.
  1. Pulse oximetry: Doctors check the levels of oxygen in the blood through a simple device called pulse oximeter attached to the baby’s finger. Blue finger tips indicate low oxygen levels.

Once the tests confirm RSV, the doctor will take the steps necessary for the required treatment.

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How To Treat RSV Infection In Babies?

The treatment of uncomplicated cases of bronchiolitis is symptomatic.

As RSV is a virus and cannot be treated with antibiotics. Medicines don’t specifically tackle the virus, so, the best treatment is to let the immune system clear the pathogen naturally. The American Academy of Pediatrics states that if a baby is well despite an RSV infection, then there is no need for medical treatment (12).

Nevertheless, the body can recover better when relieved of the distressing symptoms. The doctor may prescribe any of the below to provide relief from the symptoms:

  • Fever medication to reduce the fever and keep the body temperature under control.
  • Pediatric cough syrups to provide relief from a chronic cough and chest congestion.
  • Intravenous fluids if the infant has trouble eating or is too weak due to the infection.
  • In extreme cases of RSV infection, the doctor may give the baby a nebulizer treatment at the hospital (13). A nebulizer vaporizes medicines to inhale easily. The doctor will use a bronchodilator medicine that will relax the bronchioles and make breathing easy. Medicines and their dosage will be decided by the doctor after considering the baby’s age, intensity of infection, and overall health.
  • Ribavirin is an antiviral agent delivered through an oxygen hood, face mask, or endotracheal tube with use of a small-particle aerosol generator most of the day for three to five days. Early small trials of its use suggested a modest beneficial effect on the course of RSV pneumonia, with some reduction in the duration of both mechanical ventilation and hospitalization.
  • Nebulizer treatment can be followed by mechanical ventilation, where oxygen is pumped from a breathing machine to make inhalation easy.

Nebulizer treatment and mechanical ventilation are only employed in severe cases of RSV infection where the baby is under observation in a hospital. For most cases, the baby can have treatment at home with some help from home care.

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Home Care For RSV Infection

An infant with an RSV infection can feel better with adequate home care and attention. Here are a few tips:

  1. Use a humidifier: Dry air can make it hard for a baby to breathe when infected with RSV. A humidifier pumps water vapor in the air and maintains optimum humidity, making respiration easier. Use a cool-mist humidifier and clean it periodically to prevent any germ-buildup.
  1. Keep the baby’s nose clear: Thick mucus can make it difficult for an infant to breathe. Use a nasal bulb and clear the mucus in the baby’s nose regularly. You can use over-the-counter nasal saline drops as well after consulting the doctor (14).
  1. Provide fluids and nourishment: Give sufficient fluids, such as breastmilk and formula, to the baby. If the baby is older than a year, then you may give him water to drink. Fluids help alleviate dryness and irritation in the throat. Proper nourishment is essential for building immunity. If the baby eats solids, then provide pureed meat and vegetables that are rich in micronutrients.
  1. Keep the baby away from smoke: The baby should be kept away from pollution, cigarettes, or any other smoke thus worsening the symptoms of RSV infection.

The RSV infection can last up to three weeks in infants (15). Treatment coupled with home care will ensure that the baby gets well soon as RSV can stem several health complications.

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Complications Of RSV Infection

Following are the complications and long-term effects of RSV infection:

  1. Pneumonia or bronchiolitis: Both conditions cause severe fluid retention and airway blockage in the lungs. It deteriorates the health and requires greater medical intervention.
  1. Ear infection: RSV can easily find its ways to the middle ear causing the middle ear infection or otitis media (16).
  1. Asthma: Infants affected by a severe RSV infection face long-term risk of developing asthma. Asthma occurs due to chronic constriction of bronchioles and could compel the patient to use an inhaler for the rest of the life.

RSV infection may have fatal consequences, but mostly in high-risk infants. A study by the American Academy of Pediatrics found that RSV infant mortality rate has declined significantly from 14 in 2002 to just four in 2011 in every 10,000 infected cases (17). Nevertheless, protecting the baby from the virus is important, and below are some easy ways to do it.

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How To Prevent RSV Infection?

RSV is highly contagious, but it is also an avoidable virus. The viral infection can be prevented in infants by observing the following precautions:

  • Wash hands before touching the baby: Make sure your hands are clean and sanitized before holding the baby. Ask others to do the same before they go close to the baby. RSV can remain dormant on skin surfaces from where it can easily transmit to the baby.
  • Maintain healthy personal hygiene: Keep the baby’s hands and toys clean to prevent the little one from contracting the virus.
  • Reduce the chances of exposure: Avoid taking the baby to overcrowded places during the season when the virus spreads the most. If the baby has a sibling with cold, then limit their playtime together till the sibling has been cured. If the parent catches a cold, then they should avoid cuddling and kissing the baby until recovery.
  • Pre-medicate the baby after doctor’s consultation: The American Academy of Paediatrics recommends the use of passive Immunoprophylaxis in infants that are at a higher risk of contracting RSV (18). The medication is sold under the brand name Synagis. This drug reduces the disease’s intensity. The drug does not guarantee the prevention of RSV infection and does not inhibit the symptoms. It just makes the infection less deadly and reduces the chances of fatality. The medicine is only recommended for high-risk infants such as premature babies, babies younger than two years with congenital heart and lung problem, and those with poor immunity. Palivizumab injection of 15 mg/kg intramuscularly once a month is administered for five months during the peak RSV infection season.

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The body becomes better prepared for dealing with the virus as the infant grows. Until then some simple steps of prevention help avert the virus. Remember that RSV infection appears as a common cold, so take your baby to a doctor even at the slightest symptoms. When he is all grown up, his body will battle common cold on its own.!

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