Respiratory Syncytial Virus in Premature Babies

Premature Baby Boy
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Understanding and preventing respiratory syncytial virus (RSV) in premature babies is an integral part of bringing a preemie home.

Neonatal Intensive Care Unit (NICU) discharge is a joyous occasion; no longer do parents have to follow the routines of the hospital's special care nursery or NICU or be separated from their baby. Most importantly, going home means that the baby has made it through all of the immediate health problems caused by being born early.

Once parents bring Baby home, keeping them healthy becomes the primary goal. During the fall and winter months, preventing RSV is a preemie parent’s biggest challenge.

Overview

RSV is a common virus in the fall and winter months. It is the most common cause of upper respiratory infections in infants and children. The majority of children have their first RSV infection by age 2. Most children who have RSV recover on their own. While more than 57,000 children under age 5 are hospitalized with RSV infection per year, less than 1% of those children die.

In preemies, RSV is a major health concern. It is the number-one cause of sickness and re-hospitalization for preemies, and prematurity is the greatest risk factor for severe RSV infection.

Symptoms

In most children, RSV looks like the common cold. Infants and children with RSV may have a stuffy nose, cough, fever, and malaise.

Symptoms of severe RSV infection requiring immediate medical attention include:

  • Rapid breathing
  • Difficulty breathing
  • Cyanosis (bluish discoloration of the skin)
  • Apnea (periods of non-breathing)

If your baby shows any signs of these symptoms, you should seek immediate medical attention.

Prevention

Hand washing is the best way to prevent RSV infection from spreading. The virus can live on hands and clothing for up to 30 minutes. It is spread through the air when people with a virus cough or sneeze, or through contact with items that have the virus on them.

In addition to hand washing, eliminating risk factors helps to prevent RSV infection. Risk factors other than prematurity include:

  • Daycare
  • Caregivers who smoke
  • Crowded living conditions
  • Low birth weight
  • Multiple births
  • School-aged siblings
  • Chronic lung disease
  • Congenital heart disease
  • Exposure to environmental pollutants
  • Neuromuscular disease
  • Family history of asthma

Some of these risk factors can’t be changed, so parents should focus on the ones that can. In the first year of life, especially during the fall and winter, try to keep your preemie out of daycare environments. Make school-aged children wash hands and change clothes when they come home, avoid crowds, and don’t smoke. If you do smoke, smoke only outside and wear a jacket that’s used only for smoking and is removed when you come inside, since smoke particles stay on clothing.

Medication

For infants considered to be at the highest risk for RSV, medication is recommended. Synagis (palivizumab) is given as a monthly shot during the peak RSV season. Although it's sometimes called the RSV vaccine, Synagis is a medication and not a vaccine. Not every preemie needs Synagis, but talk to your doctor if:

  • Your baby was born at 28 weeks or less and will be 12 months or younger at the start of RSV season.

If you meet any of the following criteria:

  • Your baby was born between 29 and 32 weeks and will be 6 months or younger at the start of RSV season.
  • Your baby was born between 32 and 35 weeks, will be 3 months or younger at the start of RSV season, and either attend daycare or has young siblings living in the home.

Talk to your doctor about the potential benefits and costs of using Synagis, as experts recommend these situations be reviewed on a case-by-case basis.

Synagis can prevent up to 55% of preemie hospitalizations due to RSV. It reaches its peak effectiveness by the second dose, so talk with your doctor early in the fall to find out when RSV season is anticipated in your area.

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Article Sources
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  1. Centers For Disease Control and Prevention. Respiratory Syncytial Virus-Associated Mortality (RSV-Associated Mortality): 2019 Case Definition.

  2. Underwood MA, Danielsen B, Gilbert WM. Cost, causes and rates of rehospitalization of preterm infants. J Perinatol. 2007;27(10):614-9. doi:10.1038/sj.jp.7211801

  3. Centers for Disease Control and Prevention. RSV.

  4. Centers for Disease Control. RSV Prevention.

  5. Sommer C, Resch B, Simões EA. Risk factors for severe respiratory syncytial virus lower respiratory tract infection. Open Microbiol J. 2011;5:144-54. doi:10.2174/1874285801105010144

  6. Hashmi NA, Cosgrove JF, Macmahon P. Prophylaxis in RSV infection (Palivizumab)--is it worthwhile?. Ir Med J. 2000;93(9):284.

Additional Reading
  • Austin J. Preventing Respiratory Syncytial Virus in Homebound Premature Infants. Home Healthcare Nurse. 2007;429-432.

  • MedlinePlus Medical Encyclopedia. Respiratory Syncytial Virus Infections.

  • Synagis (Palivizumab). Potential Candidates for RSV Prophylaxis.