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There were signs about RSV posted at the main doors into our NICU unit–“It’s RSV Season!!!”–with special RSV visiting hours listed. A month later, new summer hours were posted, and siblings were allowed to visit the unit for a few hours each day–“RSV Season is Over!!!”

Fliers about RSV were posted on every bulletin board, near every sanitizing foam pump on the wall. We received an RSV brochure in our go-home packet from our unit’s social worker. Then, after discharge, as the summer drew to a close, our pede had a long conversation with us about RSV. ECI gave us information about it, as did our developmental pediatrician’s office.

All of which begged the questions: what the heck is RSV, and is it the fourth horseman of the apocalypse?

What is RSV?

It is not the fourth horseman of the apocalypse. It is, however, thought to be the leading cause of hospitalization in children under the age of 1. And for those who began their journey in a NICU, the thought of being re-admitted into a PICU can be a preemie parent’s worst nightmare.

Respiratory Syncytial Virus (RSV) is, as the name suggests, a virus which targets the lungs and airways of the respiratory system. Common symptoms include: runny nose, sneezing, coughing, wheezing, difficulty breathing, loss of appetite, mild fever. (For many infants, the more common symptoms are inactivity, loss of appetite, and difficulty breathing.) It pretty much looks like the common cold; in fact, most people will have been exposed to it by the age of two.

In healthy individuals, RSV will run its course in about a week. But preterm infants and children with asthma or other respiratory illnesses are at particular risk for developing complications from the virus–bronchioloitis and pneumonia–which can lead to re-hospitalization.

RSV and Preemies

Preterm infants are more susceptible to the risks of RSV because they are born before their lungs are structurally mature enough to support and regulate “spontaneous” breathing (which is why many preterm infants require mechanical ventilation during their first few weeks, which, in turn, can add stress to their developing lungs). Additionally, preterm infants never receive a full payload of maternal antibodies, as the bulk of it is transferred via placenta during the last few weeks of a term pregnancy.

If you are interested in a more in-depth discussion about how RSV effects preemies, Hand to Hold’s “RSV 101” has an excellent breakdown of the risks associated with RSV across the gestational age brackets of preterm infants.

The Vaccine

There is no vaccine.

The Shot

But there is a passive immunization available.The brand name is Synagis, and it has been around since 1998. It is an intramuscular injection administered every four weeks during RSV season. Although it may not prevent a patient from contracting the virus, it has been shown to reduce the severity of the illness, which enables many patients to fight it off before they develop serious complications.

The shot itself, however, is extremely expensive (we were given the price tag of $1800…per shot….per month…for six months…so needless to say, our family couldn’t do it). Not all health insurance plans will cover Synagis, and for those that do, the set of qualifications your child must meet are extremely narrow–medical history, gestational age, even siblings and daycare are all taken into account.

If your pediatrician or healthcare provider has strongly encouraged you to look into Synagis, they are doing so based on the American Academy of Pediatrics’ Red Book recommendations. Talk to your pediatrician about the treatment and any concerns you might have. If they feel very strongly that your child is high-risk, they will more than likely send a letter of appeal to your insurance company in the event your child is not covered for Synagis.

Prevention

The usual germ precautions go a long way in reducing a child’s exposure to the virus–wash hands while singing two rounds of the Happy Birthday song, avoid touching nose-mouth, regularly disinfect hard surfaces, etc–but also avoid large crowds, limit the time your infant is exposed to groups of children, and isolate from siblings who may be exhibiting symptoms.

RSV was why our healthcare team strongly encouraged us to keep our daughter out of daycare for as long as possible. We were able to make it work, but not everyone can, so definitely ask about germ protocols when finding a daycare center for your child.

Additional Information

For more information about RSV, talk to your doctor and check out the following links:

Centers for Disease Control

National Institute of Health

American Lung Association

March of Dimes

A Hand to Hold

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