RSV and Bronchiolitis – PediaCast 504
- Dr Sabine Eid and Dr Kristin Sundy-Boyles are pediatric residents at Nationwide Children’s Hospital. They visit the studio as we consider RSV and bronchiolitis. We introduce this common virus and explore the symptoms, diagnosis, treatment and prevention of its potentially life-threatening illness. We hope you can join us!
- Respiratory Syncytial Virus (RSV)
- Pediatric Residency Training Program at Nationwide Children’s
- Bronchiolitis Helping Hand
- RSV and Bronchiolitis: What Do I Need to Know?
- Winter Viruses Make a Summer Return
- RSV: When It's More Than Just a Cold
- Bronchiolitis: Diagnosis, Management, Prevention – PediaCast CME 057
- Interim Guidance for Use of Palivizumab Prophylaxis to Prevent Hospitalization From Severe Respiratory Syncytial Virus Infection During the Current Atypical Interseasonal RSV Spread
Announcer 1: This is PediaCast.
Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.
Dr. Mike Patrick: Hello, everyone, and welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio.
It's Episode 504 for October 6th, 2021. We're calling this one "RSV and Bronchiolitis". I want to welcome all of you to the program.
If it seems like we are a little on the late side in covering RSV and bronchiolitis this year, it's because we are. However, when we planned this episode, we thought our timing would be perfect, because year after year, after year, bronchiolitis kicks up in the fall, usually around November, and peaks over the winter months and then steadily declines in early Spring.
So, we thought October would be perfect time to explore RSV and bronchiolitis, which by the way, it's one of those important topics that we try to cover every year about this time, on either the parent podcast, this one, or our Continuing Medical Education podcast, PediaCast CME, which we produce for pediatricians and other pediatric providers.
Last fall, we covered RSV and bronchiolitis on the CME podcast. This year, we wanted to remind parents about the upcoming RSV season. Except, the RSV season is not upcoming, turns out it's already here. Because, for reasons we do not entirely understand, RSV season came early this year, beginning in August instead of November, which is something new to me. I've been a pediatrician for 27 years and this is a first.
Now, RSV's early arrival is likely driven by the COVID-19 pandemic. We didn't see much RSV or bronchiolitis last winter. Why? Probably because of the measures we took to limit the spread of COVID-19.
Many schools and workplaces went virtual. We stayed indoors. We avoided other people. We wore face coverings and washed our hands and kept our distance, which as it turns out, limits the spread of many viruses, including COVID and RSV.
And then, we began coming back together over the summer. Parents returned to the workplace, kids went back to daycare, schools began holding in-person classes and families traveled, and visited shopping centers, and attended birthday parties, engaged in recreational activities with other people. Which in turn, led to the perfect storm, easy transmission of respiratory viruses combined with the population whose immune systems had not dealt with these viruses in nearly 18 months.
That's the working theory anyway. We may discover a more nuanced and precise explanation as we move forward. Here in Ohio, RSV seems to have peaked and is starting a slow decline, much as COVID and Delta variant are doing.
So, what does that mean for our traditional RSV season this year, from November through March? Will we largely skip seeing RSV infections this winter? Well, that is certainly our hope that so many people have been infected with RSV recently, that we may have some community immunity as we head into winter.
Or will that immunity be short-lived? Or perhaps, even though it seemed like lots of people had RSV in August and September, perhaps there are plenty of others who avoided it, and we will see this common infection rise again in a few months. We have no idea, really. We must simply wait for time to tell.
In the meantime, we will continue asking questions and seeking answers, as we build upon our knowledge with new discoveries made, because that, ladies, and gentlemen, is how science works. So, all this to say, we are covering RSV and bronchiolitis today, because it's usually a good time to do so. However, due to our circumstances beyond our control, we are a little late to the party this particular year.
On the other hand, we do have a terrific party lined up for you, with a presentation that's a little bit different from our usual format. It's always good and refreshing to change things up a bit. Dr. Sabine Eid and Dr. Kristin Sundy-Boyles will be here shortly. They're both pediatric residents at Nationwide Children's Hospital.
And they have put together an engaging presentation for us. We'll hear what they have to say. And then, I will join them for a little Q&A to round up our time together, as we consider RSV and bronchiolitis in kids.
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So, let's take a quick break. We'll get Dr. Sabine Eid and Dr. Kristin Sundy-Boyles connected to the studio and then we will be back to talk about RSV and bronchiolitis. It's coming up right after this.
Dr. Sabine Eid: Hey Kristin, so I don't know about you, but I was working in the emergency department a couple months ago and saw several children with common colds and bronchiolitis.
Dr. Kristin Sundy-Boyles: Sabine, same, I've actually been working night shift for the last two weeks and we were seeing a ton of it. I remember when we were interns in the emergency department, and we didn't see our first cases of bronchiolitis until November.
Dr. Sabine Eid: Me, too. It's a little strange that we are seeing the cold we see in the wintertime earlier this summer, and now into early Fall. So, I think it's important to talk a little bit more about it.
Dr. Kristin Sundy-Boyles: Agree. So, let's imagine that your doctor just told you that your child has something called "bronchiolitis". Let's talk about exactly what that means.
Dr. Sabine Eid: Perfect, let's start with the definition. So, bronchiolitis is inflammation of the bronchioles, which are a part of the lungs. I like to think of the lungs as an upside-down tree. So, the tree has a trunk which is the trachea or your main breathing tube.
The trunk then divides into two large branches, which are the bronchi. Then the bronchi, which are the large branches, they divide into the smaller branches which are the bronchioles. So that, is where the bronchiolitis is.
Dr. Kristin Sundy-Boyles: The bronchioles are where we find bronchiolitis. We know that 'itis' means inflammation. So, if we break it down bronchiolitis means inflammation of the bronchioles. With inflammation, the bronchioles can become full of mucus, which makes it hard for babies to breathe.
Dr. Sabine Eid: So, when babies have bronchiolitis, they have mucus in their lungs that makes it hard for them to breathe. At first, it can look like a common cold, but babies might only have a runny nose and a cough when bronchiolitis starts.
Dr. Kristin Sundy-Boyles: After a few days, some babies might start breathing fast and they might look uncomfortable. A couple things that we look for, that you can look for in your own kids, are these three findings. The first is called retractions. That's when your babies sucks in the skin around their ribs when they breathe.
The second thing is called nasal flaring, which is when babies open and close their nostrils with each breath. And the last is called grunting, which is when babies make a noise every time they breathe out. If youâ€™re seeing any of these signs in your baby, make sure to call your pediatrician.
Dr. Sabine Eid: And sometimes, because of the symptoms that Kristin just talked about, babies might not want to drink as much milk as usual, or they may want to feed more often but take shorter feeds. Most babies do not have a fever, but some babies do.
Kristin, how do we diagnose babies with bronchiolitis?
Dr. Kristin Sundy-Boyles: Great question. So, we are able to tell if a baby has bronchiolitis just by examining them and talking to you guys, the parents. There's many diseases where we have to do blood tests, or X-rays, but we don't have to do this for bronchiolitis. Every now and then, especially in sicker babies, we'll do tests for certain viruses in bronchiolitis, but this is not necessary to make the diagnosis.
Dr. Sabine Eid: And usually, bronchiolitis is an illness that affects kids between 2 and 12 months old, but it can also happen to anyone from 0 to 2 years old. It's pretty rare in children over two but older children will have cold-like symptoms that's caused by the exact same viruses that caused bronchiolitis.
When we get common colds as adults, we probably also have inflammation of our bronchioles, but since ours are much bigger than a baby's, it shouldn't make it hard for us to breathe. Babies tend to get sicker with bronchiolitis because their bronchioles or small airways are so tiny that any little bit of snot or mucus can block them and make it hard to breathe air.
Dr. Kristin Sundy-Boyles: Bronchiolitis is most common in premature babies, babies with known lung or heart problems and babies with weak immune systems. But any baby, even healthy ones, can get bronchiolitis. Nearly every baby will have common cold or some sort of snotty illness at some point, in the first few years of his or her life.
Sometimes, it's just a runny nose but sometimes, it's more. Especially kids who are around other kids often, such as those in daycare, those with siblings, in school, or kids who are around second-hand smoking have an even higher risk for bronchiolitis.
Dr. Sabine Eid: Bronchiolitis is always caused by a virus. Babies can also get infections in their lungs from bacteria, which is called a pneumonia but that is a different type of problem. Any virus can cause bronchiolitis, but there's one particularly called RSV or respiratory syncytial virus, that is known for causing severe bronchiolitis.
Other viruses like a common cold, you might hear called rhinovirus, enterovirus, parainfluenza, adenovirus, human metapneumovirus, just to name a couple, can also cause bronchiolitis. Even the winter flu can cause bronchiolitis.
These viruses are all very contagious. So, if someone in your baby's daycare class has bronchiolitis or a friend visits with a cold, it's possible that they could spread infection to your baby.
Dr. Kristin Sundy-Boyles: You might sometimes hear bronchiolitis referred to as an RSV infection, since that's typically the most common and most severe type of virus that causes bronchiolitis. We typically see bronchiolitis in the late fall and the winter months through March, kind of like the flu season. But this has been an unusual year since we had a mild winter last year, but now, we've been seeing bronchiolitis over the summer and early fall.
We think this might be because everyone started taking their masks off, and the colds we think of as regular cold are spreading around as they usually would.
Dr. Sabine Eid: Some of the best things that you can do prevent your baby from getting bronchiolitis is washing your hands frequently, avoiding smoking inside the home or around your baby and breastfeeding your baby.
Dr. Kristin Sundy-Boyles: Unfortunately, we don’t have any medicines that we can use to treat bronchiolitis yet. For now, we mostly just support babies while their own body fights off the infection.
Some babies might need staying hydrated so we can give them IV for fluids. Other babies might need help breathing. So, we can give them oxygen, or a special air blown through their nose, or sometimes even a mask which helps push air into their lungs.
Dr. Sabine Eid: The most helpful thing of all is using a suction to get those boogers out of your baby's nose. In the hospital, we have a suction tube connected to the wall that we usually use, but you can also do this at home.
There are many different types of suctions that you can buy, from a bulb suction, where you squeeze the bulb, stick it in your baby's nose and release. Or a something called a NoseFrida, where you suck on the end of the tube, and even an electric suction machine that you can buy. We are always recommending the NoseFrida at our hospital and in our clinic, as it seems to work well for many families.
Sometimes, we will put some saltwater drops in your baby's nose to make it easier to suck out those boogers.
Dr. Kristin Sundy-Boyles: Babies with bronchiolitis tend to cough a lot. And we might be tempted to give them cough medicine like we would do for ourselves. However, it's very important that we don't. Cough medicine can be dangerous to babies, especially if it contains honey. If you aren't sure if your medication is safe for your baby, always check with your pediatrician.
Dr. Sabine Eid: We used to think that some of our breathing treatments we use in asthma would work for bronchiolitis, like an albuterol inhaler or steroids. After a lot of research though, we have learned that these don't help and babies who get these medications don't get better any faster than other babies. They also might so get the side effects of the medication without any benefit. So, bronchiolitis is sometimes a waiting game until our research finds a new medicine that helps.
Dr. Kristin Sundy-Boyles: Most importantly, we know that antibiotics do not help. They're very good at fighting infections caused by bacteria like pneumonia, but they do not work against viruses. And like we talked about; bronchiolitis is always caused by a virus.
Dr. Sabine Eid: And some babies with bronchiolitis do need to be admitted into the hospital. This usually is if they are working very hard to breathe or if they don't drink enough milk to stay hydrated. Your pediatrician can help you decide if your baby needs to go to the hospital.
Sometimes, for babies who are born very very early or needed a lot of help breathing in the neonatal ICU, we can give them medicine that helps prevent infection by RSV. Unfortunately, this medication is not available to all babies. If your baby is eligible, your pediatrician will make sure to let you know.
Dr. Kristin Sundy-Boyles: If your baby gets RSV bronchiolitis, we expect them to feel the worse on the third, fourth, or fifth day of their illness. Usually, after four or five days they start turning the corner and feeling better. This isn't always the case, but it is the most common with RSV.
This is why sometimes if you bring your baby to the hospital and it's only the second day of their illness, we'll give you very strict instructions and reasons that you might need to bring your baby back later.
Dr. Sabine Eid: We talked earlier about how most babies don't need any tests to figure out if they have bronchiolitis. So, if what you are telling the doctor and the exam the doctor sees on your baby is very consistent with bronchiolitis, no tests will be done. Of course, besides the COVID-19 swab.
Dr. Kristin Sundy-Boyles: Sometimes, we will get a chest X-ray, which is a picture of the lungs, to see if there's anything else we should be concerned about. But again, this is not a must, and it will really depend on what the doctor is seeing in your baby. Sometimes, we'll also get a swab that tests for different viruses, not just COVID-19. But again, this is necessary to diagnose since bronchiolitis can be caused by many different viruses.
The diagnosis of bronchiolitis we say is clinical, which means it is done just by listening to the history for the baby and seeing their physical exam. Even if we do test for viruses, it does not change the treatment we'll give your baby, as all viruses are treated the same.
Dr. Sabine Eid: So overall, there are a few things we want you to remember about bronchiolitis. It is very very common, especially in babies less than six months old.
Dr. Kristin Sundy-Boyles: It's always caused by a virus, and unfortunately, we don't have any medicines that make it better yet.
Dr. Sabine Eid: Sometimes, it can cause babies to have trouble breathing or to not want to eat enough.
Dr. Kristin Sundy-Boyles: You can best prevent it by careful hand washing and making sure sick people stay away from your baby.
Dr. Sabine Eid: And if you have any concerns or think your baby might have bronchiolitis, ask your pediatrician.
Dr. Mike Patrick: All right, we are back with Dr. Sabine Eid and Dr. Kristin Sundy-Boyles. First, I just want to say you guys did a really fantastic job with that. Thank you so much for putting that presentation together, I really appreciate it.
We're going to talk about things in, I wouldn't say more detail, but just really kind of hit home the important, most important points about bronchiolitis. But before we do that, let's meet our fine doctors. So, Dr. Sabine Eid, tell us a little bit about yourself. What year are you in residency?
Dr. Sabine Eid: Yeah, absolutely. I am a third-year pediatric resident, which is our last year of residency. I'm originally from Louisville, Kentucky and I plan to be an allergist-immunologist next year.
Dr. Mike Patrick: Great. So, you're applying to fellowships at this point? Kind of looking around and seeing what's out there and what's available?
Dr. Sabine Eid: Yes, I'm in the middle of interview season right now.
Dr. Mike Patrick: Great. Well, good luck to you. I'm sure you'll make a fantastic pediatric allergist, and we'd love to have you back on PediaCast once you're out there and practicing, or even when you're a fellow, if there's something allergy related that you would like to talk about. And even if you're not in Nationwide Children's.
Dr. Sabine Eid: Absolutely.
Dr. Mike Patrick: We'd love to have you back. And Kristin Sundy-Boyles, you're also a third-year resident, pediatric resident, correct?
Dr. Kristin Sundy-Boyles: Yes, that is correct.
Dr. Mike Patrick: Great. So, tell us little bit about your background and what your career plans are.
Dr. Kristin Sundy-Boyles: I'm from North Carolina. I went to med school at UNC, and I moved out here with my husband to Ohio for our residencies. I am going to be a chief resident at Nationwide next year, and after that, I'm planning on applying to a fellowship in Pediatric Hospital Medicine.
Dr. Mike Patrick: Great, perfect. That has really grown. When I was a resident there was no hospital medicine, and it's just so helpful and you got to take care of some really sick patients and learn about all sorts of disease processes. So, I'm sure that's going to be a fantastic career for you.
So, let's focus on bronchiolitis. And Sabine, remind us again the meaning of these terms. Because these are ones that parents may hear, but especially if we go a whole summer without, well, except this year, but normally, we go a whole summer without thinking about RSV and bronchiolitis. And then, it hits again in the fall and we kind of forget what these things are. Remind us, what is RSV versus bronchiolitis. How are those words different?
Dr. Sabine Eid: Absolutely. So, they're different but also kind of go together so when you think of bronchiolitis, it's an infection of the lungs and it's the lower part of your lungs caused by a virus. It could be caused by RSV, which is respiratory syncytial virus, but it doesn't always have to be. It could also be caused by any virus that's out in the community. So just because someone says your baby has bronchiolitis, it does not automatically mean RSV bronchiolitis.
Dr. Mike Patrick: Yeah, we see this a lot where parents want an RSV test, because maybe RSV was going around their daycare and now their child has a cough and maybe some noisy breathing. But like you said, the identification of that virus does not impact how it's treated. It's going to be treated the same, regardless of which virus it is.
So, it's not really all that important that we identify whether it's RSV versus another virus, because they can all do it. And even though RSV tends to be the one, when you have severe bronchiolitis, it's more likely to be RSV. But most kids with RSV do not develop severe bronchiolitis. Most of them have mild symptoms. It's the small number of them that end making it to the hospital.
Seems like a lot to us because those are the ones we see, but for everyone we see there's probably thousands who have mild disease that never come to the hospital or see anyone. So, I guess that's reassuring.
And then, the exception to that, of course, is COVID-19. We do want to test for that because that does make an impact because then you got to stay home for ten days, regardless.
So, if your baby's in daycare they can't go back. With RSV bronchiolitis, once the fever's gone and they're feeling better, they can go back. But with COVID, you really do have to stay home for at least ten days. So then, how common is bronchiolitis, Kristin?
Dr. Kristin Sundy-Boyles: It's very common. We see it a lot in pretty much every different setting we take care of kids. So, we see it in clinic. And like you said, many of those babies never have to go to the hospital. We do see it quite a lot in the emergency department. And often, we're able to send those babies home, too.
But then we're seeing a lot of it in the hospital right now as well, both on the regular floor and even sometimes, in the intensive care unit. So, it's definitely one of the most common illness that we take care of in the pediatric world.
Dr. Mike Patrick: And not only here in the United States. I mean, globally, there are 34 million cases of bronchiolitis each year around the world. And that results in 3.4 million hospitalizations. So, it is the most common cause of infant hospitalizations in the world.
And in terms of global deaths by a single infectious agent, it comes in number two. Number one is malaria, and number two is respiratory syncytial virus.
It does not take COVID into account, those numbers are from pre-pandemic days. But just gives you an idea that this is a really, really common problem around the world.
Now, you mentioned some risk factors for developing severe bronchiolitis. Remind us what some of those are.
Dr. Sabine Eid: So, some of the risk factors to develop severe bronchiolitis could be if your baby was born very very early, if your baby has heart condition, if your baby's around second-hand smoke that can sometimes make it a little bit worse. Those are some of the biggest things.
Dr. Mike Patrick: And if any baby who has an immune system issue, could have more severe disease, and then also certain neuromuscular conditions, because you may not be able to make an effective cough if you have a muscle problem. That can be an issue as well.
And then, what signs and symptoms do we see with bronchiolitis?
Dr. Kristin Sundy-Boyles: The most common thing we see is just all the runny nose and congestion and kind of that snotty baby picture that we have all imagined. And I'm sure any parent out there with a baby has dealt with a runny nose in their kid. And that tends to be the most common in the first symptom we see.
What makes bronchiolitis different from a regular cold is that then in addition to the runny nose, you will see more of a cough and you might see those signs of increased work of breathing, like the tugging in around your ribs, the grunting sound and even that nasal flaring.
Dr. Mike Patrick: And babies, unfortunately, are what we call obligate nose breathers, meaning they don't really know how to change their breathing patterns. So that they start to breathe through their mouth when their nose is really stuffy. So, when their nose is clogged up with mucus, they're still going to try to pull air in and out through their nose, even though it'd be easy just to, hey, breathe through your mouth. You'll move air a lot easier.
But babies don't really know how to do that until they get a bit older. You can't tell them to do it, obviously. So that becomes a big issue in why it's so important to keep that mucus out of the nose.
And then, that leads us to what causes these signs and symptoms. And there really is a lot of mucous production, not only in the nose but also down in those little bronchioles, as you mentioned, right?
Dr. Sabine Eid: Yeah, absolutely. I feel like most of the time, when you just have the common cold, it's like in your nose, your mouth, your throat, the bronchiolitis gets really down in the lungs.
Dr. Mike Patrick: And not only with mucus, but you also got inflammation, which is swelling. And so, if the tube that carries the air down there deep is really narrow, it doesn't take much inflammation to really block off those tubes and make it difficult for air to get in and out.
So, you mentioned that there are other things that can cause similar signs and symptoms. What are those things that we worry about that could look like bronchiolitis but aren't necessarily that?
Dr. Kristin Sundy-Boyles: So definitely a common cold is a classic thing. And it will have the same symptoms of the runny nose and congestion, even a cough and maybe a fever. Other types of infection that you can get would be pneumonia, which we generally think of as a lung infection caused by a bacterium instead of a virus. Though you can also have pneumonia caused by viruses.
So, pneumonia is one of the most common other things that we think of in a baby with bronchiolitis. But also, when babies are having trouble breathing, we think about if they might have accidentally breathed in a very small object blocking an airway. Or if they have some other type of infection in their throat or their neck that's making it push on their airway and be hard to breathe.
Dr. Mike Patrick: And that kind of comes back then to whether we need to get a chest X-ray or not. Most kids who have typical symptoms of bronchiolitis are not going to need an X-ray. But if we're worried about pneumonia, then that's a good thing to determine whether a bacterial pneumonia is actually there or not.
So, if you had a baby who may be, you say it's worse during days three to five and if you're out pass day five. And now they're getting worse, that's not typical, or if they have a fever that's lasting more than two or three days, or if they had a fever, it went away, and a new fever comes. Whenever there's something that's a little atypical about the way that they're presenting with bronchiolitis, then we may think, well, there could be something complicating this, whether that be a pneumonia or, as you mentioned, a foreign body that they've aspirated. And getting X-rays may be helpful in determining if those things are going on.
So, once we do determine that this is bronchiolitis, remind us again, how do we treat this illness?
Dr. Sabine Eid: Yeah, absolutely. So, bronchiolitis can sometimes be treated at home. And then, sometimes the baby has to come to the hospital. And your pediatrician will help you decide whether it's the best for your baby. But if you're at home, it's important to make sure that they're eating well, peeing well, and if you can try to suction up their nose, that would be the best thing. We usually recommend either a bulb suction like we talked about or a NoseFrida.
But sometimes, if your baby is breathing really hard, not eating very well, they might have to come into the hospital, where we usually will start with doing the same thing as suctioning up their nose, sometimes giving them some IV fluids and really just watching and seeing how they do.
Dr. Mike Patrick: So really what we would call supportive care, whether that's at home or in the hospital. Just getting that mucous out of there, providing them with extra oxygen if they need it. If they're not eating really well, giving them IV fluid so they don't get dehydrated. And that's really about all we can do.
Now, when I was training, well, you said, okay, for bronchiolitis, you're not going to use steroids like you would in asthma. Steroids are not going to help and in fact, you need a good strong immune system to fight the virus off, so steroids would not be indicated.
However, we did use albuterol with every baby that had bronchiolitis back then. And this is, I think, is a great example of how science helps medicine change. And we've even seen this during the COVID-19 pandemic where recommendations at the beginning of the pandemic evolved and changed.
And some would say, well, science doesn't know what they're talking about or we don't know what we're doing. But really, that's what science is all about, is adjusting and making changes as new information and knowledge comes to pass. And that has certainly happened with bronchiolitis because we know that albuterol, maybe it makes them sound a little bit better right after you give the breathing treatment.
But you're also giving them moisture. And moisture, and moisture we know helps dissolve mucous in the nostril. So now they're breathing air better but is it because of the medicine or is it because of the humidity through the breathing treatment that helped them sound a little bit better?
But we know that albuterol also has a lot of side effects. It makes your heartbeat faster. Kids, who, if you have asthma and you use your inhaler, it can make you feel kind of anxious and on edge. And so, babies who are having trouble breathing, the last thing they need is to feel like their heart's beating fast and they're anxious and on edge, when they're just trying to breath. And the albuterol is not really helping them.
And so, we don't use that anymore. I guess an exception would be in older babies. Like if they're nine months to 24 months and there's a really strong history of asthma in the family, or they were premature, and we know that they have lung disease from their prematurity. There certainly are exceptions, but most babies with bronchiolitis were not going to use those bronchodilators anymore.
So, what are some reasons then that kids with bronchiolitis would need to be admitted to the hospital? What are the criteria for admission for bronchiolitis?
Dr. Kristin Sundy-Boyles: Yeah, that's a great question. And I kind of like to think of it in three categories. And so, the first one and probably the most common is if they have decreased oxygen saturation, which we can check in the emergency department or in the clinic. And we like for that number to be higher than 90%. And so, babies are having trouble breathing in enough oxygen, we will often need to admit them so we can give them oxygen in the hospital.
Another thing is if they're working very hard to breathe. And this is tricky because it's actually different than the oxygen problem. If you're having a hard time getting air in, even if you have normal oxygen, you might need help with the pressure of breathing. So that's when we'll sometimes blow air really fast in through the nose, which we call high flow, or even sometimes use a mask that blows air in through the nose and mouth to make it easier for babies to breathe.
And then the last thing is hydration. So, we're talking about if the baby can't eat because their nose is so stuffy and babies have to breathe through their nose when they're breastfeeding or bottle feeding, we might need to give them extra hydration through an IV. And so that is usually the third type of reason why a baby would need to come into the hospital.
Dr. Mike Patrick: Great. And then, what can happen if a baby is having some of those issues and they don't come into the hospital. Parents say, no, I don't want him admitted. I just want to go home. What complications can occur if bronchiolitis is not supported really well in those severe cases?
Dr. Sabine Eid: So, if bronchiolitis is not supported in those super severe cases, some complications that can happen is your baby can stop breathing which is called apnea. Or sometimes, they might just have something that you called breathing failure where they need us to help support them breathe.
Dr. Mike Patrick: So, babies can die from bronchiolitis if they are not given the support they need when things get severe, right?
Dr. Kristin Sundy-Boyles: Yeah, that's true. That's kind of the big scary thing that we all want to prevent. And so, getting the baby into the hospital so we can monitor them closely, really makes us feel better that we can intervene when we need to.
Dr. Mike Patrick: Yeah, perfect. Now, what about prevention? Let's say parents don't want to go down this road at all to begin with. And so, how can we best prevent bronchiolitis from occurring in our babies?
Dr. Sabine Eid: I feel like preventing bronchiolitis in our babies is very similar to preventing viruses in general. So, the important things are still important, like washing your hands. If your baby is sick, try to keep them away from other kids. Those are the two biggest things.
Dr. Mike Patrick: Yeah, absolutely. Now, you did mention that there is a medicine that can be given to particularly high-risk babies. And it's interesting because with COVID, we've also heard about a similar medication called monoclonal antibody therapy. And this is where you inject antibodies that are going to attack the virus. So, it's not your own body making the antibodies or giving you the antibodies that can attack it.
And we have those available for RSV. So, the antibodies that attack respiratory syncytial virus. Palivizumab is the generic name. Synagis is the most popular brand name of that.
And for the pediatric providers in the crowd, I'm going to put a link into the show notes to Interim Guidance from the American Academy of Pediatrics. So, it's for this RSV season right now. It's called Interim Guidance for the Use of Palivizumab Prophylaxis to Prevent Hospitalization from Severe Respiratory Syncytial Virus Infection During the Current Atypical Interseasonal RSV Spread. Got to love that. That's the title of the article.
Dr. Mike Patrick: And I will put a link to that in the show notes so folks can find it easily. Just had some advice on what to do with Synagis this year since we're seeing so much RSV so early.
Now, it is interestingly an effective vaccine against RSV. It's certainly being studied but it has proven tricky to produce. So hopefully, in the coming years, we'll have a vaccine to prevent RSV, but it's not here yet. And I know that investigators even here at Nationwide Children's Hospital have been working on that.
We did a show on the CME podcast last year where we talked in-depth about the science of RSV and then trying to make a vaccine. And I'll put a link to that in the show notes as well. So, folks who are interested in kind of a really deep dive on RSV and bronchiolitis, that's worthy of Continuing Medical Education. I'll put that in the show notes as well so folks can find that easily.
All right, so we have talked with two pediatric residents at Nationwide Children's Hospital. Remind us, where does residency fall in doctor training? There's so many parts to becoming a doctor. I think it can be confusing for folks to understand. What exactly is a pediatric resident?
Dr. Kristin Sundy-Boyles: So, a pediatric resident is someone who has finished medical school. So, they're already a doctor but they're still learning their chosen specialty. So, this is typically somewhere between three to five years after medical school where we're learning in kind of an apprenticeship type way.
So, we will be the primary doctors on patients in the hospital and in clinics, but we're supervised. So, which means there's an attending doctor, a doctor who has finished their residency, kind of watching over us making sure we make the right choices and helping guide us and teach us as we make our way through residency.
Once you finished residency, you can either go on to be a fellow, which is choosing a subspecialty, or you can choose to be a general pediatrician or a general whatever your specialty is. And go right on to being an attending.
Dr. Mike Patrick: so, it's really a long, long process. However, it's a process that really never completely ends because there's lifelong learning for physicians because, as we've said along the way here, science is all about evolving and changing as we learn new things. And so, if you're going to be a physician who's practicing evidence-based up-to-date medicine, you need to continue to learn as we move forward.
For those out there who are interested in becoming a doctor after high school, you want to be premed as an undergraduate, that's four years. And then four years of medical school, and then residency, and then the fellowship, and then practice after that. So, it's a long road but it's definitely a rewarding one. You can make such a big difference in so many folks' lives.
Now, you are both pediatric residents at Nationwide Children's Hospital. Tell us specifically about that program.
Dr. Sabine Eid: Yeah, so Nationwide Children's Hospital is a very large pediatric program in Columbus, Ohio. There are general pediatricians, but we are categorical peds residents. And then we also have some medicine/pediatric residents in our program, as well as pediatrician who are also studying either neurology or genetics.
So, there's a lot of us residents who cover the whole hospital and work in different clinic and in the emergency room, we're kind of everywhere.
Dr. Mike Patrick: And I can vouch for that program on two levels. Number one, I'm an alumnus, so I did my residency at Nationwide Children's Hospital. And then I work for the hospital and I work with you guys both in the emergency department and work with residents. It's really one of the best parts of my job, actually, is being able to work alongside and help teach our pediatrics. Really fantastic.
And of course, Nationwide Children's, one of the five largest pediatric hospitals in the United States, we have nearly one million patient visits per year and treat patients from all 50 US states and over 20 countries. We have one of the nation's largest pediatric primary care community networks. So, we just take care of so many kids around the community and one of the nation's busiest emergency departments as well.
So bottom line, if you do your pediatric residency at Nationwide Children's, you pretty much see everything. And of course, we have so many terrific teachers here too, that if you are interested in pediatrics, I would highly recommend looking into the residency here in Columbus at Nationwide Children’s Hospital.
Well, Dr Sabine Eid and Dr. Kristin Sundy-Boyles, I appreciate you stopping by so much.
We are going to have a lot of links in the show notes for you. We'll have a link to the Pediatric Residency Training Program here, also some educational articles on bronchiolitis and RSV, both from our hospital and also from the American Academy of Pediatrics. And then, that link to that really in-depth look at bronchiolitis and RSV and trying to create a vaccine from the PediaCast CME podcast.
Again, all of those links will be in the show notes over at pediacast.org for this particular episode, which is 504.
In the meantime, Dr. Sabine Eid, and Dr. Kristin Sundy-Boyles, thank you so much for stopping by today.
Dr. Kristin Sundy-Boyles: Thank you so much for having us again.
Dr. Sabine Eid: Yeah, thank you so much.
Dr. Mike Patrick: We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that.
Also, thanks to our guests this week, Dr. Sabine Eid, and Dr. Kristin Sundy-Boyles, both pediatric residents at Nationwide Children's Hospital.
Don't forget, you can find PediaCast wherever podcasts are found. We are in the Apple and Google podcast apps, iHeartRadio, Spotify, SoundCloud, Amazon Music and most other podcast apps for iOS and Android.
Reviews are helpful wherever you get your podcast. We always appreciate when you share your thoughts about the show. And we love connecting with you on social media. You'll find us on Facebook, Twitter, LinkedIn, and Instagram. Simply search for PediaCast.
Also, if you are a pediatrician or another pediatric provider, don't forget about our other podcast, PediaCast CME. That stands for Continuing Medical Education. It's similar to this program. We turn the science up a couple notches and offer free Category 1 Continuing Medical Education Credit for those who listen.
That include doctors, nurse practitioners, physician assistants, nurses, pharmacist, psychologist, social workers, and dentists. And since Nationwide Children's is jointly accredited by many professional organizations, it's likely we offer the exact credits you need to fulfill your state's Continuing Medical Education requirements.
Of course, you want to be sure the content of the episode matches your scope of practice. Shows and details are available at the landing site for that program, pediacastcme.org. You can also listen wherever podcasts are found. Simply search for PediaCast CME.
Thanks again for stopping by. And until next time, this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids. So, long, everybody.
Announcer 2: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.