Dr. Erika Kube: Respiratory disease RSV in kids — what are symptoms, why it's rising - The Columbus Dispatch

The Columbus Dispatch

Three-month-old Julia came to the emergency department with her parents for nasal congestion and coughing. As the nurse walked them back to her room, I quickly peeked in the car seat and saw that Julia was sucking on her pacifier and did not seem to be in any acute distress.

While the nurse completed her triage and obtained a set of vital signs, I looked up Julia's chart in the computer to see if she had ever been seen in the emergency department (ED) before. She hadn't, but I saw that Julia had been born prematurely and spent a few weeks in the NICU before being discharged home.

Julia's parents were calm but very worried about her. They said she had not been taking her bottles as well as she normally did because her nose was so congested, and she had been coughing for several days. They had been suctioning her nose with a bulb syringe, especially before feedings.

RSV: Respiratory disease showing up early at Nationwide Children's Hospital

I asked if anyone else in the family had been ill but her parents said no. They had kept Julia away from crowds and didn't believe she had been around anyone who had been sick. She was also up to date on her immunizations and had been seeing her pediatrician regularly since she left the hospital.

What I started examining Julia, I noticed her nose was very congested. Newborns breathe through their noses unless their nasal passages are blocked and generally do not start mouth breathing until they are several months old. She kept trying to breathe through her nose but struggled because of all the mucus.

As I listened to her lungs with my stethoscope and looked at her chest, I noticed that her chest was retracting or sinking in under her rib cage with each breath — something I hadn't noticed earlier because she was in her car seat. The sides of her nose were also flared out in attempt to get more air into her lungs, all of which raised my concerns about how the severity of Julia's illness.

I ordered a COVID and an RSV swab on Julia as well as a chest X-ray. She had a fever when she arrived, so I ordered a dose of Ibuprofen and I asked the nurse to suction out her nose to help her breathing. Within about 30 minutes I had the results back: Julia's COVID test was negative and her RSV test was positive.

RSV and COVID: What are the differences between the two viruses?

RSV, respiratory syncytial virus, is a viral illness that is the most common cause of inflammation of the small airways in the lungs (bronchiolitis) and pneumonia in infants. This inflammation can partially or completely block the airway causing a wheezing sound making it difficult for air to get down into the lungs. Early symptoms can be subtle, such as decreased appetite, runny nose, and slight cough. Irritability, decreased activity, and apnea (which are pauses while breathing) can also be present in very young infants. Chest retractions and nasal flaring are signs of more severe illness indicating the infant is having respiratory distress.

RSV can affect all ages but causes the most problems for the very young and the very old. RSV bronchiolitis is the leading cause for hospitalization in infants. Most babies have been infected with RSV at least once by the time by the age of 2. Babies who are born prematurely or with lung or heart conditions or immune deficiencies are at much higher risk for severe illness. About 1%-2% of children younger than six months of age with RSV require hospitalization.

There is no treatment or cure for RSV, but it is important to ensure that patients are adequately hydrated. Fever and pain can also be treated with Tylenol and ibuprofen. Those in severe respiratory distress may require oxygen through a tube in the nose or a mask over the mouth. In more severe cases, the patient may need to be put on a ventilator. Most cases of RSV go away on their own within a week or two.

RSV infections tend to follow a seasonal pattern, with most cases typically starting in the fall, peaking in the winter and tapering off in the spring. An unexpected consequence of the COVID pandemic was that there was a decline in respiratory illnesses such as RSV during the winter months in 2020. There is speculation as to what role social- distancing and mask wearing played in this decline. However, cases of RSV rose in the spring 2021 as COVID vaccinations became prevalent and social distancing and mask requirements were relaxed.

Julia's chest X-ray showed inflammation consistent with bronchiolitis and RSV infection. The nurse suctioned her nose, which improved her breathing, but she continued to have visible retractions in her chest. Because of her premature birth, young age, and the exam findings, I transferred her to Nationwide Children's Hospital where she was hospitalized. She required supplemental oxygen via a mask over her face for a few days. Thankfully her condition did not worsen and she didn't need a ventilator. She was discharged home after a few days in the hospital.

Dr. Erika Kube is an emergency physician who works for Mid-Ohio Emergency Services and OhioHealth.

drerikakubemd@gmail.com