Bronchiolitis and RSV
A serious health threat
to newborns and premature infants
Toni Karimian RN, CPN
T.C. Thompson Children’s Hospital
Chattanooga, TN
Most children will have had symptoms of cough and wheezing with or
without fever by the age of 2 years. The symptoms are the same as the
common cold, and for older children and adults, that’s exactly what it is.
This is not the case for newborns and premature infants. Due to their small
size, newborns and infants are susceptible to the excess mucus produced in
response to the virus, clogging tiny airways. Since infants are naturally
nose-breathers, they are at greatest risk for complications. Bronchiolitis is
most common in Winter.
Definitions
What is Bronchiolitis?
(Bron-key-o-Lie-tus)
A lung infection that can be caused by several kinds of viruses, including RSV. Most
children will be sick for about 12 days and a child remain symptomatic for up to 21 days!
What is RSV?
Respiratory Syncytial Virus
(Sin-sish-ul)
A viral illness transmitted by airborne droplets that are produced from sneezing or
coughing and from direct contact of contaminated hands. Once an infant is exposed,
symptoms appear within about 4 days. The duration of illness is usually about 2 weeks.
Prevention is the key!
Avoid exposing your baby to sick contacts. Anyone with upper
respiratory symptoms, including family members, should be kept away
from new babies. Upper respiratory symptoms include:
Coughing
Sneezing
Runny nose
Protect your baby!
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Do not let others kiss the new baby or get in their face.
Do not smoke around baby or let others smoke either!
Wash baby’s toys and bedding frequently.
Avoid crowded daycare conditions
Avoid church nurseries
Avoid busy stores or crowded restaurants
Always wash your hands before touching baby and ask others to
wash their hands before touching baby.
Tip:
Ask your baby’s doctor if they could be at risk for RSV. Most
pediatricians encourage parents to keep newborns away from public
places for at least 6 weeks after birth. Premies are at a greater risk for
complications of RSV/Bronchiolitis than a full term, healthy infant.
Bronchiolitis can be serious!
For babies who were born early, or prematurely, and infants who were born with
lung problems, RSV can be harmful.
Complications can range from: Pneumonia
Future lung problems, such as asthma
Death
Signs of RSV and Respiratory Distress
Early signs of RSV include: Sneezing
Stuffy or runny nose
Sore throat
Fever greater than 100.4 rectally
Irritability
Trouble eating, drinking, or sleeping
Lethargy or severe listlessness
Hard to awaken or excessive sleepiness
(newborn babies should wake every
3-4 hours to eat)
Signs of serious problems that occur suddenly should be treated in the
Emergency Department or call 9-1-1 immediately!
Serious signs of respiratory distress include:
Wheezing
Cough that doesn’t stop or causes vomiting
Trouble breathing
Fast breathing
Blue or gray colored skin
Inability to take food or drink
When do I call the doctor?
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Anytime you have a question about a change in your child’s health status
The baby seems very sick
Premature infant with history of lung problems or cold symptoms
Any infant less than 6 months of age with cold symptoms
Treatment Options
Bronchiolitis is caused by viruses – not a bacteria - and antibiotics have no effect on decreasing the
recovery period. The goal is to control symptoms until the body’s natural immunity has time to
combat the infection. Controlling the spread of RSV germs is most important.
What will be done if my baby is admitted to the hospital?
Assess for signs of dehydration
For infants unable to meet their nutritional and fluid needs,
IV fluids or tube feedings may be needed.
Assess the circulating oxygen level in the blood
Pulse oximetry or saturation levels may be checked periodically,
though this is not a truly accurate test.
It is non-invasive and can be affected by skin temperature, improper probe placement, or
even movement.
Chest x-rays may or may not be done if complications,
such as pneumonia, is suspected.
Blood Tests
For the critically ill child, blood tests to assess arterial blood gases (ABG) may be
needed, as well as, complete blood counts and electrolyte panels.
RSV Directogen is a collection of mucus from the nasopharyngeal (nose and throat) area.
Since this is an aspirate of secretions, it also is dependent on collection technique and
amount of specimen collected. It may not be performed on all patients who show
symptoms of RSV.
We do not yet have a vaccine to protect our babies from RSV. We do, though, have an
immune globulin that gives temporary immunity to a select group of infants. These
immune globulins are given to premature babies who are at greatest risk for lifethreatening RSV infections.
The best prevention is good hand washing and keeping small babies away from
anyone known to have RSV or cold symptoms.
Home Care
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Encourage fluids
Clear nasal passages with bulb suction prior to each feeding
Strict hand washing by all
Infant acetaminophen may be needed to decrease fever or help with
irritability
TIP: Always check with your baby’s doctor prior to giving any
medication to your baby!
TCTCH CONTACT NUMBERS
Baby’s doctor name and number ________________________
778-kids
(5437)
TCTCT Emergency Department
778-6101
or
9-1-1