10 Lessons I Learned About RSV in the NICU
I’d vaguely heard of respiratory syncytial virus (RSV) prior to having my third baby. From my understanding, it was a rough virus for babies and of course, something to be avoided if possible. Many parents, including myself, have learned the hard way this year that RSV can be quite serious. This is particularly true for young babies whose airways can become clogged with mucus and because it can cause bronchiolitis, an inflammation of the airways. As you can imagine, a baby’s airways are already quite small so additional swelling caused by RSV symptoms can lead to significant breathing problems. I’ve since learned that every year an estimated 58,000 children under five are hospitalised and RSV is the leading cause of hospitalisation in all infants.
RSV symptoms look remarkably similar to the common cold making it a bit tricky to determine how concerned parents should be.
According to the CDC, the symptoms of RSV include:
- Runny nose
Sounds a lot like the common cold, doesn’t it? Mildly symptomatic RSV is also managed and treated quite similarly to a cold when at home. In the best case scenario, which is often the case for adults and older children, RSV is treated with fluids , rest, and fever reducers. Not all babies require hospitalisation – thankfully! However, babies under six months and preemies often require additional support so it’s important to err on the side of caution and avoid exposure as much as possible. For babies, the treatment can require a hospital stay if breathing issues arise.
My newborn was six days old when my two older children began coughing at night and running low-grade fevers. I did my best to keep the baby isolated but a few days later he began showing signs of congestion. After watching him throughout the night, we decided to bring him into the children’s urgent care since he was breathing rapidly. I felt a bit silly thinking they would send us home, but he was rushed to a children’s hospital from the ER in an ambulance and put on oxygen and a feeding tube immediately.
From there, we embarked on a two-week journey I never could’ve imagined just a few days earlier after bringing my healthy baby home from the hospital. I hope some of the lessons I learned about RSV in babies and children during that difficult time can give some insight to others facing this challenging illness.
- Watch your baby’s body for strained breathing. There were several telltale signs the nurses in the NICU looked for when caring for my baby in the NICU: flaring nostrils, pulling at the ribs or between each rib, skin pulling inward at the neck, using neck muscles to breathe, and head bobbing. Any of these are a sign you should go to the hospital immediately. Oxygenation should always be in the high nineties; by the time we reached the hospital our baby was in the low eighties. Move quickly if you see any of these signs of laboured breathing!
- It will get worse before it gets better. I know it sounds ominous but typically the virus peaks around days three to five. However, there is some variability. My baby’s peak was closer to days eight to ten. It’s normal for breathing to become more laboured during that time and hospitalised babies with RSV typically require more oxygen support. It can feel really upsetting to see your child or baby with RSV getting worse for several days in a row, but this is a typical trajectory for RSV in infants, children, and adults.
- Clearing congestion is the most important thing. RSV causes an immense production of mucus which can block tiny baby airways. The nurses in the NICU used strong nasal suction to clear my baby’s nasal passages nearly hourly during the peak of the illness. Saline and a nasal aspirator are your best friends when caring for a baby with RSV symptoms. We loved the FridaBaby Nose Frida. The hospital provided us with a Nose Frida when we were ready to go home. That’s how you know it’s a good choice! It’s also vital to use a cool mist humidifier if you’re treating RSV in your child or baby at home. When my baby was on oxygen the hospital also had cool mist going into his airways via a cannula.
- You can’t breastfeed a baby on oxygen. This was one of the most challenging parts of having a baby hospitalised for RSV. There’s a risk of aspiration when a baby is on oxygen support so the hospital will insert a feeding tube. There’s no breastfeeding allowed until your baby can breathe on a very low level of oxygen. If you’re a breastfeeding mum, this means you’ll be pumping around the clock to produce enough milk to feed your baby through the feeding tube.
- It’s a seasonal illness. RSV is usually most prevalent in late autumn through early spring. However, as we all know, lockdowns, masking, and a lack of typical exposure have changed how pathogens behave. Consequently, RSV season has been less predictable as behaviours have shifted back toward pre-pandemic times.
- You can test for RSV. RSV in children looks a lot like a bad cold. However, the symptoms of RSV tend to be more aggressive in babies. A quick nasal swab turned up a positive RSV result in the ER. Doctors tend not to test for RSV since there’s no medication available to treat it. However, I was told I can always ask for an RSV test for any of my children if they are symptomatic.
- The longer-term effects may linger for a bit. Babies with RSV are often sick for up to two weeks and can be contagious for a month. Babies and children with RSV often get sicker more frequently in the following months due to the damage caused to their airways.
- There’s no vaccine and no medication available for RSV. Vaccine trials are currently underway, but no vaccine is available as of the writing of this article. Antibiotics aren’t used to treat RSV since it’s viral. Acetaminophen and ibuprofen may be given for a fever.
- RSV is highly contagious. The virus spreads through droplets that can live on surfaces for hours. It’s nearly impossible to prevent the spread when you have other small children with RSV in your home. Adults are often asymptomatic but can still spread the virus.
- Symptoms improve quickly after the peak. The NICU nurses kept telling me that my baby would turn a corner, and this would all be behind us. It was hard to believe them when it seemed like he was getting sicker by the day. Sure enough, after the peak was over, we were able to nearly remove him from oxygen within a day. We did go home on what the hospital called “a whiff” of oxygen. It was disappointing to leave the hospital still attached to tubes but we were able to wean him off the oxygen within a few days. The good news: many babies are able to go home with no supplemental oxygen!
RSV isn’t always serious in babies but it’s definitely something to be taken seriously. Most children have had RSV by the time they turn two and it’s considered a normal childhood illness. Keeping an eye out for worsening symptoms and breathing difficulties if you suspect RSV is crucial – and keep your nasal aspirator handy!
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