Respiratory Syncytial Virus, or RSV, is a widespread virus that infects the respiratory tract, causing mild, cold-like symptoms in most older children and adults. Apnea is a separate condition defined as a temporary cessation of breathing. While many infants recover from RSV without issue, the virus can trigger apnea in a vulnerable minority, turning a standard illness into a serious medical event.
How RSV Causes Apnea
The pathway from an RSV infection to apnea begins in the bronchioles, the smallest airways in an infant’s lungs. The virus causes inflammation and swelling in these passages, a condition known as bronchiolitis. This inflammation is accompanied by a substantial increase in mucus production. The combination of swollen tissues and thick mucus narrows and can obstruct these airways, making it physically harder for an infant to breathe.
This increased work of breathing forces the infant’s body to expend a great deal of energy. The muscles used for respiration can become overworked, leading to physical exhaustion. This fatigue is a contributing factor to apnea, as the infant may simply become too tired to continue breathing effectively against the high resistance in their airways.
A final element is the immaturity of the infant’s central nervous system. The respiratory control center in the brainstem is not yet fully developed in very young babies and is responsible for sending rhythmic signals to breathe. The stress of the illness, combined with airway obstruction and fatigue, can interfere with this signaling process, causing the brain to momentarily “forget” to send the signal. This results in central apnea, a pause in breathing originating from the brain.
Identifying Apnea in Infants with RSV
An apnea event is defined as a pause in breathing that lasts for 15 to 20 seconds or longer. Sometimes, a shorter pause can also be classified as apnea if it is accompanied by other indicators of distress, such as a change in skin color or muscle tone.
One of the most noticeable signs is a change in the infant’s skin color, a condition called cyanosis. This often appears as a bluish or purplish tint on the skin, particularly around the lips, inside the mouth, and on the face. On darker skin, this discoloration may be more apparent on the gums or under the fingernails. The infant may also suddenly become limp or floppy due to the lack of oxygen.
It is helpful to distinguish this from periodic breathing, a normal pattern in newborns. Healthy infants can have irregular breathing with very short pauses lasting only a few seconds, followed by a series of rapid breaths. These pauses are brief and are not associated with any change in color or muscle tone, unlike the more prolonged and alarming event of RSV-related apnea.
Infants at Highest Risk
Certain groups of infants are more susceptible to developing apnea as a complication of an RSV infection. These include:
- Premature infants, particularly those born before 32 weeks of gestation, because their respiratory and neurological systems are underdeveloped.
- Infants with a low birth weight, as their size often corresponds with less developed organ systems.
- Babies with chronic lung disease of prematurity, also known as bronchopulmonary dysplasia, who already have compromised lung function.
- Infants born with specific congenital heart diseases, as the strain from respiratory distress can be poorly tolerated.
- Children with weakened or compromised immune systems, who have a reduced ability to fight off the initial RSV infection.
Hospital Treatment and Monitoring
An infant suspected of having RSV-associated apnea requires hospitalization for close observation and care. The primary goal is not to cure the virus, as there is no specific antiviral medication for RSV. Instead, treatment focuses on supportive care, helping the infant’s body manage symptoms while it fights off the infection.
Monitoring
Upon admission, the infant is placed on continuous monitoring equipment. Cardiorespiratory monitors track heart rate and breathing rate constantly, sounding an alarm if breathing pauses or if the heart rate drops. A pulse oximeter, a small sensor wrapped around a foot or hand, measures the oxygen saturation in the blood, providing a real-time assessment of oxygenation.
Supportive Care
Gentle nasal suctioning is performed regularly to clear mucus from the airways, reducing obstruction and easing the work of breathing. Maintaining proper hydration is also a focus; intravenous (IV) fluids may be administered if an infant has difficulty feeding. If monitoring shows low blood oxygen levels, supplemental oxygen is provided through a nasal cannula.
Advanced Respiratory Support
Should these measures be insufficient and apnea episodes become frequent, a higher level of respiratory support may be necessary. Heated high-flow nasal cannula (HHFNC) therapy delivers warm, humidified air and oxygen at a higher rate to help keep airways open. Continuous Positive Airway Pressure (CPAP) uses a mask or nasal prongs to deliver constant, gentle air pressure to prevent the airways from collapsing.