"THE HEART OF THE MATTER"
a special program of the National Emergency Medicine Association (NEMA)


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Week: 606.6

Guests: Dr. Michael Speer, Assoc. Prof., Baylor College of Medicine, Houston, Melanie Sweeney, Partners in Intensive Care, Washington, D.C.

Topic: RSV - respiratory syncytial virus

Host/Producer: Steve Girard

NEMA: Each fall, pediatricians and pediatric hospital units brace themselves for the beginning of the RSV season. What? You haven’t heard of RSV? You’re not alone. Today we have Melanie Sweeney of Partners in Intensive Care in Washington, D.C....and Dr. Michael Speer, of the Baylor College of Medicine in Houston. Dr. Speer, give us an idea of the differences between RSV and a cold....

SPEER: Well, unfortunately RSV in an adult, or an older child, or even an older infant...may act just like a severe cold. And it’s very difficulty to distinguish that particular illness from something that’s milder. It starts out with a lot of mucus coming out of the mouth, and a little low grade fever, and a cough. But in a small baby, it attacks the airways...and it narrow the airways, causing difficulty in moving oxygen from the outside air into the bloodstream. And this is particularly true in the very small, premature infant who’s been born less than 32 weeks gestation, that is, earlier than 8 weeks from due date. And in that premature baby who has chronic lung disease called bronchopulmonary dysplasia, or BPD, it can be even more devastating.

NEMA: This is an infection that most of us don’t know too much about...until it strikes, looks like a cold, and then becomes a severe infection...

SWEENEY: I think the biggest problems that parents face is that most often, they’ve never heard of RSV before their child is diagnosed with it. So, we are trying to mount a proactive campaign here to get information out to parents before their child gets sick, because when parents do play an active role in the health care team, working in partnership with their child’s doctors, they can, in fact, prevent infections like RSV. And just in general, the more they know about the medical risk to their child, especially when they’re dealing with a baby who is born prematurely, or has chronic conditions like BPD....the more they know, the better. So, one of the things that we’ve done to help educate families about RSV is to set up a toll free hotline that parents can call to get some free information about RSV and RSV prevention. And that number for parents is 1-888-RSV-4449.

NEMA: Is there an age at which the chance of a baby getting RSV diminishes?

SPEER: There is no less risk of contracting it, adults can get RSV, and that’s on way that babies can get RSV...is from adults. And in adults, they’ll have kind of a hacking cough and a stuffed up nose, and a little low grade fever, and they may feel a bit under the weather, but that’s about it. Unfortunately, the small baby can get pneumonia and a much more significant infection from the same virus that doesn’t cause big problems for the older person. The best way to prevent RSV infections is really common sense...and that includes hand washing before you pick up your baby, keeping people with colds and flu symptoms away from your baby, trying to avoid large crowds because you can’t escape those folks that are coughing all around you...and don’t smoke in the house, because smoking actually sets up the airways of these babies for getting infection from RSV.

NEMA: I’ve heard about a preventive treatment that involves use of Respigam....

SPEER: And Respigam is a preventive measure. It is a new product that is on the market...only this year. It is an immune globulin that is given by vein, once a month through the RSV season, and it has been shown to markedly, in tests, to markedly reduce the risk to the premature infant of getting RSV infection. This is a somewhat scarce product...it is a costly product, and it really needs to be used only for those high risk babies...the premature baby born less than 32 weeks gestation, and particularly the premature baby that has chronic lung disease, or BPD. These are truly the highest risk group, and the most at risk for rehospitalization and even death.

NEMA: Is Respigam treatment a growing option for physicians and families?

SPEER: Well, the American Academy of Pediatrics, of which I am a member, recommends this particular product for this high risk group...as I said, the high risk group...the patients who were born early, and the patients born early in particular who have chronic lung disease. And the patient born early, we recommend the product be given when the patient is certainly less than six months of age...and in some babies, even between six months and 12 months of age. The patient who has chronic lung disease, especially those who have been on oxygen within the last six months...or who are presently receiving extra oxygen, we recommend this product through the first two years of their life, in other words, up to 24 months.

NEMA: I guess in this case. information equals the power of prevention...

SWEENEY: The most important thing is that parents and doctors have an open line of communication...and so, we’re hoping that physicians are talking to parents about this...in our advocacy work with hospitals...trying to make sure that before the babies who are born prematurely get discharged home, they get information about RSV...things like that. And I think what Dr. Speer’s talked about, the most important things that parents can do are just common sense....things like washing your hands a lot before touching your baby, keeping the baby from people who may have colds or fevers...not in crowded places and no smoking. It’s very common sense, and we hope that the word spreads as they hear about RSV. And it’s not just families of high risk babies that need to know about the risk....all families really should, because if you’re taking your kids over to someone else’s house, you need to know these things also.

SPEER: It should be noted that not just premature infants can get sick with this virus and be admitted to hospital. Older infants, term babies can certainly...in fact, I just saw a recent article that almost two percent of term babies can be rehospitalized...and these are normal term babies...can be rehospitalized with RSV infection each year. RSV infections result in 90 thousand hospitalizations a year, and 45 hundred deaths...so it’s not a trivial matter.

NEMA: Many thanks to Dr. Michael Speer of Baylor College of Medicine in Houston and Melanie Sweeney of Parents in Intensive Care from Washington, D.C. Remember that your child is at risk of contracting a serious form of RSV if born more than 8 weeks premature, or if the child has bronchopulmonary dysplasia, a chronic lung condition. So, use the common sense tips of keeping the child away from people with colds, crowds of people, and smokers...and if he or she comes down with deep respiratory congestion and coughing, wheezing or any breathing difficulties...go see your doctor...who may talk with you about a preventive inoculation with Respigam, which can provide protection up to 2 years of age.

SPOT: Small pages....big advice on parenting...from infants to teens. What to expect, emotionally and physically, as your child grows. How to develop positive discipline,how to deal with kids and TV, adolescent issues, drug education, fighting, single and step parenting...it’s all in the ‘Little Book of Parenting, available through the National Emergency Medicine Association. Call 1-800-332-6362 for more information.

NEMA: Thanks for joining us for today’s program. If you have any comments or suggestions, contact this station. Or visit our home page at:

www.nemahealth.org/

...for a look at transcripts of this or past programs, or to find out more

about the National Emergency Medicine Association. I’m Steve Girard at The Heart of the Matter.

 

 

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Last modified: December 17, 2021