Introduction

Respiratory syncytial virus (RSV) is one of the most common viruses affecting the respiratory system in children, frequently showing more severe symptoms in infants as bronchiolitis. In comparison, older children tend to experience mild illness resembling that of the common cold.

In this article, we will explore RSV, its effects on newborns, ways to prevent it, and what parents can do if their baby contracts the virus.¹

What is RSV?

RSV belongs to the family of viruses called Paramyxoviridae. As expected, it is highly contagious and spreads through droplet aerosols when an infected person coughs or sneezes or through direct contact with the infected person. The highest incidence of cases of RSV is during the fall and winter months but can occur at any time of the year. Immunocompromised children, premature infants, those with chronic lung disease, and neonates with NICU admissions after birth are more likely to suffer serious illness than healthy individuals.

RSV has 11 viral proteins on its outer shell. Of these proteins, 2 have an affinity for the respiratory epithelium (airway lining) and help fuse the virus with the cells lining the airways. The virus then multiplies in the airways, destroying the cells and they cease to perform their normal function.²

How does RSV affect newborns?

Newborns are particularly vulnerable to RSV due to their immature immune systems. The maternal antibodies do not provide sufficient protection against RSV infection. It also depends on factors such as prematurity, immunocompromised state, neuromuscular disorders (NMDs), underlying respiratory conditions, structural anomalies rendering the lungs more prone to infection, and environmental factors, such as parental smoking. Children with cystic fibrosis, recurrent aspiration pneumonia, tracheoesophageal fistulas, and neuromuscular or genetic conditions are more prone to infection as these prevent good secretion and respiratory clearance. Age has remained the most significant risk factor as children have smaller diameter airways, impaired respiratory capacity, and a lower respiratory reserve. Clinically, this means that obstruction is more significant in children than in adults or the elderly, who have wider airways and better reserves. Interestingly, gender also plays a role in semiology. It has been found that RSV illness is likely to be more severe in male infants due to the smaller diameter of their airways compared to female infants.

Symptoms of RSV infection

• A persistent cough - the most common presentation in neonates
• Wheezing
• Low-grade fever
• Runny Nose
• Difficulty feeding/ reduced feeding due to nasal congestion and respiratory discomfort.
• Increased breathing work- flaring nostrils, heaving chest, recessions of the ribs and just below them

In severe cases, symptoms can include:³

• Bronchiolitis (inflammation of the small airways in the lungs)
• Pneumonia
• Sepsis
• Respiratory failure

Treatment and management of RSV in newborns

Supportive care is the primary treatment for infants with RSV infection. The severity of the illness also determines the treatment. Most infections are mild and can be treated at home. In cases where the cough is persistent, or the fever is high, your doctor may suggest admitting your baby to keep a closer watch and provide treatment in the hospital. 

Signs to be mindful of include increased effort in breathing, which may present as nasal flaring, chest retractions or heaving, grunting sounds during inhalation, a lethargic demeanour, reduced feeding, and a bluish tint to the lips, tongue, or palms. Treatment would include:^4,5

• Monitoring O2 saturations and respiratory rate
• If the baby develops serious respiratory issues, healthcare professionals may offer oxygen therapy and additional supportive treatments to assist in the baby's recovery
• Oxygen supplementation treatment should be initiated and administered when oxygen saturations fall to 90% for children aged six weeks and older, and 92% or lower for infants under six weeks or those with any pre-existing health issues
• Suctioning: clearing the baby's nasal passages. It is, however, not routinely recommended
• Continuous Positive Airway Pressure (CPAP) can be considered in rare cases with impending respiratory failure
• Chest physiotherapy for children with existing comorbidities however is not typically performed as a standard procedure
• Ribavirin
• Palivizumab prophylaxis

Preventing RSV in newborns

Here are some steps parents can take to reduce the risk of their baby contracting RSV:⁶

• Hand hygiene: wash hands frequently with soap and water, especially before touching the baby's face
• Ensuring adequate hydration: hydrate by offering frequent feedings, whether breast milk or formula
• Using a humidifier: this keeps the air moist and can help alleviate respiratory symptoms and ease breathing
• Close monitoring: keeping a close eye on the baby's symptoms and seeking medical attention if they worsen or if the baby is having difficulty breathing
• Avoiding close contact with infected sources: although this can be tough, keeping your child away from potential or known sources, such as anyone presenting with respiratory symptoms, is important
• Keep your baby's environment clean: regularly disinfect commonly touched surfaces and toys to prevent the spread of germs
• Breastfeeding: breastfeeding provides newborns with antibodies that can help protect them from infections, including RSV
• Avoid smoking: keep the baby away from cigarette smoke, as exposure to smoke can increase the risk and severity of respiratory infections

FAQs

What are the first signs of RSV?

Runny nose, congestion, decrease in appetite, coughing, sneezing, fever, and wheezing.

Is RSV a serious illness for babies?

RSV is a serious respiratory infection. If not treated quickly, this virus can be life-threatening, especially in younger children, as their condition can deteriorate rapidly.

Should a baby with RSV be hospitalised?

The majority of babies typically recover from RSV on their own without facing any complications. The virus is common, and they usually won't require hospitalisation.

How long will RSV last in babies?

Symptoms of RSV generally persist for a period of 7 to 10 days, although they may extend beyond that, particularly if they result in additional serious health issues.

Summary

RSV is a common virus that colonises the airways and can cause significant illness in newborns. While most cases are mild and resolve on their own with supportive care, severe cases can lead to serious respiratory complications. Parents can take steps to reduce the risk of their baby contracting RSV, such as practising good hand hygiene, avoiding close contact with sick individuals, and keeping the baby's environment clean. If a newborn does develop symptoms of RSV, it is essential to seek medical attention promptly to ensure appropriate treatment and monitoring. With proper care and precautions, parents can help protect their newborns from the effects of RSV and promote their overall health and well-being.