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Forum Name: Pediatric Topics

Question: 2 month old with RSV in hospital


 AuntToJosiah - Mon Feb 20, 2006 2:15 pm

My 2 month old nephew was taken to the hospital last night. After a spinal tap, blood and urine tests they decided he has RSV. He was a full term baby weighing 9.6 at birth and now weighing over 13 pounds. He was diagnosed with reflux last week. But he has not yet been put on meds for the reflux.

Anyway, I am confused because they were only going to keep him over night to watch him in case he had a sleep apnea episode. His temp was 102. They said the RSV had not yet gone into his chest but, of course, they expected it to.

His white blood cell count was slightly low last night but they didnt seem too worried about it. Said he was fighting an infection so that was normal. Today they are worried about it and did cultures although I don't know what kind. They arent letting him go home either and his temp has only gotten higher.

Why would they be worried about his white blood cell count today and not last night (cancer?!) and what cultures might they be running? What else could be wrong? My whole family has been sick the last week so it isnt suprising the baby got sick but since I have a 6 year old son (he was a preemie and never got rsv thankfully) and we havent been exposed to them we havent gone to visit or anything. So my information is sort of limited.

Any help or information would be greatly appreciated!!

Mary Jo
 MichelleRNC - Tue May 16, 2006 11:51 am

Hello. I know this reply is a liitle late, but maybe it could help someone else.

The American Academy of Pediatrics recommends that all infants under 4 months old presenting with fever, with out a known sourse of infection be admitted to the hospital for what we call a septic work-up, or rule out sepsis. The sepsis work up usually consists of routine labs, along with blood, urine, and spinal cultures. If the doctor has a known sourse of infection they may not do a full septic work-up. For example if your 2 month old nephew has a sibling or another close contact who was known to have RSV, and your 2 month old nephew presented with RSV symptoms, the doctor may not choose to do a complete septic work up, and just treat the RSV. RSV presents a lot like pneumonia (diagnosed by chest x-ray, and listening to the lungs), and RSV can turn into a pneumonia. RSV can also lead to an episode of Apnea. Babies with RSV tend to vomit up the thick mucus caused by the virus so the doctor might have wanted to hold off starting reflux medications so see if it was true reflux or just caused by the virus. We test the nasal secretions for RSV, so it's fairly easy to know if a baby has it or not. However we'll see babies who are RSV negative and present the same as those who have it- yet they may just have another virus like the flu, pneumonia, or less likely a chronic respiratory disease like Cystic Fibrosis.

It sounds to me that your nephew was sick admitted for a septic work up, and was found to be RSV positive. Now when treating a patient you don't just look at lab values, or even radiological tests- the most important thing is the infants respocse to the treatment! How do they look, are they responding well to treatment?

As for your concern about the white blood count- it changes in responce to infection- can go either way (high or low) but not uncommon to be normal or on the lower end for a virus. It is usually elevated with bacterial infection. You didn't say the number so I don't know how low it really is- but you said slightly low so it dosen't sound alarming to me at all. The cause for concern with a low white blood count is troblle fighting off infection. Now you asked why did they worry about the white count today and not yesterday- and probably because the fever went higher, and we tend to repeat blood cultures during a high fever because that's when they will be most accurate, and if bacteria is in the blood (which is true sepsis) it will be detected in the culture. The negative thing about cultures is they take a while to get the results back. A Microbiologists looks at the cultures every day and gives a progress report on what he sees- if he see's nothing it's negative. They won't call it negative until no groth has been seen for a few days. So the cultures done originally may be negative- if they even know the results of it( takes 2-3 days), and on repeat during a high fever they could come back positive- which needs to be treated with IV antibiotics and the specific kind to kill the bug that grew on the cultures. If it's just fever from virus you nephew dosent need antibiolics, it wont hurt him (aside from possible side/adverse effects or allergic reaction) but it wont help him either. The doctor has to weigh numerous factors to decide how to treat. With RSV we are most concerned with their breathing.

I hope this was able to address your concerns. I hope your nephew made a complete recovery. This past winter RSV presented earlier and we saw late cases- at least in New Jersey we did.

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