Every year as winter approaches, many children around them catch colds, coughs, and fevers... These are indeed common diseases in autumn and winter, but we still need to remind parents: Don’t take it lightly! Because during this period, there is also a virus that makes pediatricians look forward to it, which is the "respiratory syncytial virus" (RSV). Its early symptoms are very similar to a cold, and are easily ignored by parents, but may lead to severe pneumonia in children, high mortality rate for infants under 6 months of age, and there are no special antiviral drugs and vaccines so far.
Today, we asked Guo Yan, deputy chief physician of the Department of Respiratory Medicine of the National Children's Medical Center and Beijing Children's Hospital to talk about the characteristics of this disease and how to reduce the harm it brings.
can easily cause children under 5 years old to suffer from pneumonia
In the pediatric clinics of major hospitals, when winter comes, small patients with respiratory diseases are crowded. Some children are not old, their faces are red and their lips are blue. When they are close, they can still hear "slight" sounds in their throats. Doctors will be highly vigilant when they see these symptoms. It is likely that this is not a cold, but an respiratory infection caused by respiratory syncytial virus infection.
Respiratory syncytial virus is a major virus that is prevalent worldwide and causes acute lower respiratory tract infections (mainly bronchiolitis and pneumonia) in children under 5 years old. It is also the primary factor in hospitalization for infants and young children due to pneumonia, and seriously threatens the healthy growth of children. It is reported that around 30 million children under 5 years old worldwide are now suffering from respiratory syncytial virus infection, and about 10% of children need to be hospitalized for treatment, and the mortality rate can account for 13%-22% of the deaths from acute lower respiratory tract infection. Among them, infants under 6 months of age are the most dangerous, with the highest hospitalization rate and mortality rate after illness.
Respiratory syncytial virus also has a significant epidemic season in northern my country, mainly concentrated from November to February of the following year, and in southern my country, it is more common in winter and spring. According to statistics, the incidence of respiratory syncytial virus infection in Chinese children ranks fourth in the world.
Early symptoms are similar to colds
Respiratory syncytial virus infection is most likely to affect the respiratory system, and there are three main pathogenic mechanisms: airway obstruction, bronchial smooth muscle spasm and airway hyperresponsiveness. First of all, respiratory syncytial virus infection can cause the fall of airway cilia and airway epithelial cells, and the shedding substances accumulate in the airway. At the same time, excessive secretion of mucus and edema of the airway will aggravate the airway obstruction, so children will experience symptoms such as excessive phlegm, blocked phlegm, and difficulty breathing. Secondly, after infection, the airway nerve endings release a large amount of active substances, causing the bronchial smooth muscle to spasm and contract, and the child experiences wheezing and "slight" wheezing sounds in the throat or lungs. Third, infants and young children are prone to hyperresponsiveness after respiratory infection, which is closely related to the repeated wheezing of children after growing up and the occurrence of bronchial asthma .
After the infection of the child, the early symptoms are mostly cold-like symptoms, such as fever, nasal congestion, runny nose, cough and hoarseness. Some children may develop bronchioles or pneumonia, and these children are mostly less than 2 years old. If you experience cough and wheezing after 2-4 days of illness, you may experience shortness of breath, nodding breathing, difficulty feeding, mental depression, etc.
Note that children with the following high-risk factors are prone to develop severe symptoms after infection: premature birth, low birth weight, age <> Down syndrome , immunodeficiency and neuromuscular diseases, etc. This type of child should be given special protection during the virus epidemic season.
From the perspective of prognosis, cough and asthma caused by respiratory syncytial virus infection is most severe within 3 to 5 days of onset, and most of them recover quickly after that without leaving any sequelae. However, children with infancy infections are more likely to develop asthma in the future than those without infections. Children with premature babies, chronic lung diseases, congenital heart disease or underlying diseases such as Down syndrome and immune function defects have a higher proportion of respiratory sequelae after infection and recovery.
In addition, since respiratory syncytial virus infection is more common in infants and young children, the symptoms of cough and wheezing are not specific, so it needs to be distinguished from the first attack of bronchial asthma, foreign body inhalation, and congenital abnormal airway development. For example, pay attention to whether the child has allergic manifestations such as eczema, , urticaria, allergic rhinitis, , whether the relatives have a history of allergic diseases such as asthma, and whether there is a history of foreign body inhalation, and whether there is continuous throat or wheezing after birth. These can help differential diagnosis. Among them, eczema, urticaria, and allergic rhinitis are manifestations of allergic constitution . Whether relatives have allergic diseases such as asthma reflects the family genetic history. If the child experiences repeated cough and asthma on this basis and has no direct relationship with respiratory infection, it is necessary to pay attention to the possibility of bronchial asthma.
How to judge the severity of the child's condition
How to judge the severity of the child's condition? The severity of the disease can be assessed based on the child's mental state, feeding volume, breathing frequency, breathing fatigue, whether he or she is moaning, and blood oxygen saturation. When the child becomes irritable, the feeding volume is less than half of the usual amount, and the breathing frequency is > 60 times per minute, it means that the condition is moderate to severe, and parents should take their children to medical treatment in time. In the doctor's opinion, if the child is in good spirits, has no limit on his diet, has rosy lips, is normal or slightly fast in his breathing rate, and does not have obvious difficulty breathing, it means that the condition is mild.
Once the child is seriously ill and is hospitalized, in order to ensure medical safety, reduce cross-infection, and visitation is limited, many parents are concerned about how their children receive treatment. For this disease, clinicians mainly take strict observation of changes in the condition and symptomatic treatment. 1. Observe the child's performance, monitor the blood oxygen saturation, review the lung imaging as appropriate, and evaluate the changes in the condition; 2. Atomize the suction to ensure the unobstructed respiratory tract. When the blood oxygen saturation continues to be less than 90%-92%, give oxygen therapy; 3. Ensure nutritional supply: If the child can eat breast milk normally, breastfeed it. If the child's respiratory rate is greater than 60 times per minute, and there is a lot of respiratory secretions and is prone to vomiting and choking, causing missed aspiration, consider nutritional intake of nasogastric tubes, and provide intravenous nutrition if necessary; 4. Sensitivity of respiratory syncytial virus For lower respiratory tract infection caused by infection, recombinant human α-interferon will be used for antiviral treatment in routine basic treatment; 5. For children with respiratory syncytial virus infection with wheezing symptoms, bronchodilator (such as β2 agonist alone or in combination with anticholinergic drugs) can be tried, and then the clinical effect can be observed. If the symptoms are relieved, they can continue to be used, and if there is no improvement, they will be considered to stop using wheezing children with allergic constitution or a family history of allergic diseases, atomized inhaled glucocorticoid combined with bronchodilator can be tried.
It is necessary to remind parents that when treating respiratory syncytial virus infection, antibacterial drugs are not recommended as routine medications, and it is not recommended to give children preventive medications.
still has no vaccine to prevent it, but also rely on washing hands frequently
Although we know that respiratory syncytial virus is an important pathogen that causes severe respiratory infection in infants and young children, the current laboratory testing methods are relatively mature, so it is not difficult for doctors to make correct diagnosis. But unfortunately, at present, there is no respiratory syncytial virus vaccine or special antiviral drugs in the world. Moreover, respiratory syncytial virus infection cannot produce permanent immunity, which means that existing treatment methods cannot protect children from reinfection.
Because there is no specific treatment for respiratory syncytial virus infection, daily prevention and post-mortem maintenance are particularly important.
direct contact is the most common transmission route of respiratory syncytial virus. It is mainly infected by contacting virus-containing secretions or contaminants through the nasopharyngeal mucosa or eye mucosa. Droplets and aerosols can also cause transmission. We recommend that family prevention start from these aspects: advocate breastfeeding for at least 6 months; avoid exposure to tobacco and other smoke; limit high-risk infants to child care facilities during the epidemic season; wash their hands in any place; and avoid exposure to droplet-borne environments. The virus can survive on hands and dirt for hours, and during epidemic seasons it also requires frequent hand washing and reduced contact to prevent transmission.
Pay attention to the warmth of the room after the disease is maintained, and the ventilation and lighting are good. Generally, the indoor humidity is about 50%. Die reasonably, ensure that the nutrition is comprehensive and balanced, and eat a small amount of meals during feeding to avoid choking and coughing. The child loses a lot of water due to fever and wheezing, so he needs to ensure his daily fluid intake; pay attention to respiratory isolation, use the items separately, and parents who come into contact with the child should strengthen hand hygiene to prevent the spread of pathogens; if wheezing affects the quality of sleep, you can follow the doctor's advice to give atomized inhalation before going to bed to relieve symptoms, improve sleep quality, and prolong sleep time.
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