RSV. Review on Knowing More About Diseases / Illness

RSV

RSV, or respiratory syncytial virus, is the most common cause of lower respiratory tract infections in infants and children.  Although everyone can get RSV, younger children are at risk for developing major complications from this disease.

All children will have been in contact with RSV by the age of three.  Most will exhibit only cold s/s.  Some, however, will be hospitalized.  Others will require vigorous treatments at home to avoid hospitalization.  This review will focus on infants and children under two years of age.

SIGNS AND SYMPTOMS OF RSV

RSV initially presents as a common cold with a mild cough and runny nose. These mild s/s last for about 3-4 days. Fever may be present and up to 104 F if a secondary infection is present. The symptoms then become more severe with irritability(seen in infants before respiratory failure), wheeze, productive cough, dyspnea, increased respiratory rate, nasal flaring, retraction of the respiratory muscles, and finally, cyanosis, apnea, respiratory failure.

DIAGNOSIS

The diagnostic tool most successful in confirming RSV is a smear from the nose and throat of the infant, the RSV smear.

Other tests may be ordered to evaluate the severity of the disease.

TREATMENT

Treatment of RSV is focused on alleviating symptoms and preventing respiratory failure.

Pediatricians should be alerted to the following symptoms:

1. Fever over 101 F

   
   




2. Yellow, gray, or green, thick nasal d/c

   
   




3. Productive cough

   
   




4. Mucous which is yellow, green, or gray

   
   




5. Decreased urine output

   
   




6. Decreased fluid intake

   
   




7. Chest pain

   
   




8. Difficulty breathing

   
   




9. Increased respiratory rate

   
   




10. Cyanosis(blue color around lips or fingernails in children)

    
    




11. Decreased alertness

    
    

The pediatrician will dictate the specific treatment.  Here are some therapeutic measures that may be ordered by the doctor.

If able to manage at home, the air temperature should be maintained at 70-72 degrees F.  This will keep the atmosphere from becoming too dry.  DO NOT use a vaporizer or humidifier. This may make symptoms worse.  This is still being researched. Suction the nose frequently to provide an easier path for air.  Use Vaseline or an antibiotic ointment around the nose if it becomes irritated.  Saline(salt-water) nose drops can be instilled to help with nasal suction. Always close one side of the nose when suction the other side. This will enable more successful results.  Fluids must be encouraged often, even if only several drops per hour.  Dehydration will happen quickly in the presence of fever and rapid breathing.  Eliminate cigarette smoke in the house.  Minimize contact with anyone that does smoke.  Administer medications as directed by physician.  Some suggestions could be:

1. Fever control with non-aspirin products. Please check with your doctor and use the products recommended.  Ibuprofen may not be preferred for infants and younger children.  Acetaminophen may be a recommendation for fever control. I prefer Advil or Motrin at my house.  These medications tend to relieve fever and aches quicker than the competitors.  Please check with your doctor.

   
   




2. Expectorants may be ordered to encourage cough and the expectoration of mucous from the lungs.

   
   




3. Medication that dilate the bronchial tubes may be ordered to widen the bronchioles and thereby increasing the amount of mucous expelled from the lungs.

   
   




4. A nebulizer may be ordered(this is a devise used in the delivery of inhalation medications) in order to deliver medications directly into the respiratory tract.  Breathing, many times, becomes much easier after one treatment.

   
   

A strong cough medication with no expectorant is contraindicated in the treatment of RSV.  In rare cases, a mild suppressant may be utilized at bedtime to help the patient rest.  This is only done at the discretion of the doctor. If the child does not cough up the mucous in the lungs, respiratory failure will most likely be the outcome.

PREVENTION

Children and infants at risk must be identified prior to RSV season.  Early identification of RSV symptoms will directly effect the severity and duration of the illness.  Here is a list of children and infants considered to be at risk:

1. Premature infants, those born at or before 32 weeks gestation

   
   




2. Premature infants, those born between 32-35 weeks gestation with other chronic conditions

   
   




3. Any infant 6 weeks old or younger

   
   




4. Infants with chronic lung conditions such as bronchopulmonary dysplasia and cystic fibrosis

   
   




5. Any child, age two and under, with a compromised immune system

   
   




6. Infants and children under age two, living in crowed conditions at home

   
   




7. Exposure to cigarette smoke

   
   




8. Attendance in day care

   
   




9. Presence of older siblings at home

   
   




10. Infants not breast fed

    
    




11. Male infants(No joke, males cannot fight disease as effectively as females.  This has been researched.  When I worked in the newborn nursery, premature females improved at a faster rate than premature males.  Proving once again females are the stronger sex!)

    
    

After the babes at risk have been identified, the doctor will order Palivizumab.  This medication can prevent RSV, or at least decrease the severity of the disease. After the parents are contacted and permission granted to administer the drug, the insurance companies of all the patients must be contacted for approval. This is, unfortunately, the most difficult part of prevention.  Due to the cost of the medicine, insurance companies will stop at nothing to justify a denial.  I could write a book on my hatred of insurance companies, but that I will save for another day.

The medication for prophylaxis is more than one thousand dollars per injection.  There will be at least five injections, one per month.  It is not a quick procedure.  A qualified individual must assess vital signs before the injection and several times thereafter.  If the insurance company denies payment, an appeal will be forwarded.  Still, many times, it is denied.  But five thousand dollars for preventive measures is less expensive than the cost of hospitalization.

The injections are started at the onset of RSV season.  The season varies around the world, but somewhere between September and December the medicine should be started.  The injections stops at the end of the season, between March and May.  Health departments in your area can be contacted for the exact start/stop dates.

Respiratory infections can be minimized with a few precautions.  Always use good hand washing techniques. Make sure this is understood by anyone touching the infant.

Keep anybody with cold symptoms away from your newborn.  If the in-laws get mad, either offer a mask for the face or make it up to them later.  If you come down with cold s/s, do the best you can.  Support from your family is essential.  Your spouse must help with the baby.

Do not allow any older children around the babe, especially those with cold s/s.  Do this for at least 5-6 weeks after the baby is born.  Older children carry strong, contagious germs.

Do not allow smoking around children and if possible, do not allow people that smoke around the newborn.  Smoke stays on your clothes, even when you smoke outside.

Keep your infant away from crowds, especially during RSV season.  Churches are crowed places too.  Do not take a newborn to church until 3-6 weeks of age.  Ask your pediatrician about specific recommendations.