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One of the most common respiratory pathogen in newborn is RSV. From the mucosa of nasopharynx infected individuals, the virus spreads to the lower respiratory tract causing infections like acute bronchiolitis or pneumonia after an incubation period of 3 to 5 days. The virus can also spread via blood and infect extrapulmonary tissues of the infants. This case report describes the case of RSV infection from an infected mother to her offspring.
Respiratory syncytial virus is an enveloped RNA virus belonging to the family of Paramyxoviridae1, leading to about 27 hospital admissions per 10,000 infants leading to almost 55,000–88,000 deaths per year in infants less than 5 years, with most of them occurring in the developing countries 2. The virus enters the host through the mucosa of nasopharynx or conjunctiva, spreads to the lower respiratory tract and can cause infection which is characterized by necrosis & edema of the respiratory tract mucosa leading to obstruction of the airflow 3. The incubation period of the virus varies from 2 to 6 days 1.RSV can spread hematogenously to bone marrow where the virus stays latent 6.Vertical transmission of the virus has been shown in animals, but not in humans.
Herein, is a case report of a newborn with severe respiratory distress soon after delivery from the mother with evidence of RSV infection during the pregnancy.
A baby girl born in August 2018 at 36 weeks of gestation via normal vaginal delivery.
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Maternal screening for TORCH infections,HCV,HBsAg, and HIV, all were negative. The baby was first born of a non-consanguineous parents .
Birth weight was 3,220 g and Apgar score was 7 at 1minute and 8 at 5minutes. The baby was appropriate for gestational age,with nasal flaring and severe subcoastal &intercoastal retractions. Positive pressure ventilation was started. Examination revealed grunt, b/l rhonchi, increased heart rate (178/min), tachypnea (74/min) and spO2 of 91% at room air . ABG revealed a pH of 7.06, paO2- 32 mm Hg, Pco2-65 mm Hg. Chest X-ray showed diffuse granular opacities, mild perihilaropacities on both sides suggesting RDS. Broadspectrum antibiotics were started, and the patient was transferred to NICU for NIV via nCPAP at 5 cm H2O, and an umbilical venous catheter was placed. CBC showed normal values, blood and urine cultures turned out negative.
After 6 days of continuous pressure positive ventilation,CXR was taken , which revealed an area of consolidation in the perihilar region of the left lung. Serologic tests detected raised anti-RSV IgM and anti-RSV IgGtiters.
In view of all the above findings in the baby,serologic tests were performed for the mother,which showed raised anti-RSV IgM , IgA and IgGtiters. Detailed history taking revealed that the mother along with other family members had cough during her second trimester. After 15 days of life, the newborn’s respiratory distress settled and serologic tests came back negative. Baby was discharged on day 17 of life.
RSV is one of the major respiratory pathogens in infants, causing significant morbidity and mortality overall 2.The infection varies from mild URI symptoms to severe diseases (bronchiolitis or pneumonia). Reinfections are common, but less severe10. The mode of transmission was always thought to be horizontal or through direct contact. However,evidence suggested that vertical transmission might occur.
The present report describes a case of neonatal RSV infection showing transmission from a previously infected mother to her newborn daughter. In the case described,the child’s mother reported cough during her pregnancy,associated with serological evidence of RSV infection. Her newborn was born in respiratory distress with onset of the respiratory symptoms immediately after birth,vertical transmission seems to be the only plausible way to explain the clinical manifestations. In the above discussed case , the symptomsof lower respiratory tract were already present at birth, which strongly suggests infection occurring before birth rather than after.
Newborns with early respiratory distress warrant regular follow-up for the possible ocurrence of wheezing.
The most important inference is that the passive prophylaxis with currently offered only to infants at high risk,should be considered in expecting mothers to prevent pre &peri natal infections. Active immunization for pregnant women could be proven useful where RSV is still an important cause of infant mortality.
Respiratory Syncytial Virus (Rsv) Infection in a Neonate. (2024, Feb 08). Retrieved from https://studymoose.com/document/respiratory-syncytial-virus-rsv-infection-in-a-neonate
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