When baby Francisco presented the first symptoms that resembled a cold in June this year, his parents took him to the hospital immediately.
At the time, 6 months old, the boy had already been diagnosed with asthma symptoms, so any sign of coughing or secretion caused alarm in the family.
After going to the emergency room, Francisco was sent home with a diagnosis of allergies and some medications. But just 48 hours later, his condition worsened profoundly.
“He was very panting, with his chest rising and falling. He was clearly trying very hard to breathe,” says his mother, Camille Pasquarelli, 30.
“He also moaned a lot and had difficulty sleeping”, recalls his father, Daniel Ferreira, 31. “That’s when we decided to go back to the hospital.”
As soon as he went through the screening, it was found that the oxygen saturation in the baby’s blood was very low and Francisco would need to be subjected to mechanical respiration.
“He spent a few hours on oxygen, but he still wasn’t breathing properly. So the doctors decided to intubate him,” says Daniel.
Francisco spent more than two weeks in hospital with a diagnosis of bronchiolitis. During this period, he spent 13 days using mechanical ventilation, sedated.
“If I could leave a message for other parents it would be to always pay attention to the little signs”, says Camille. “It was very important that we paid attention to the changes in Francisco’s breathing and took him to the hospital immediately.”
“The doctor said if we had waited another day it could have been fatal.”
‘The smaller the child, the greater the commitment’
In addition to Francisco, another 18,172 children up to 2 years old were hospitalized in Brazil in 2023 with RSV (respiratory syncytial virus) until the end of October, according to Fiocruz’s InfoGripe Bulletin. In the same period, 222 deaths were recorded.
RSV is associated with up to 75% of cases of bronchiolitis, an inflammation that makes it difficult for oxygen to reach the lungs, and up to 40% of cases of pneumonia in children under 2 years of age, according to the Brazilian Society of Pediatrics (SBP).
“Bronchiolitis is a clinical condition characterized by inflammation that leads to narrowing of the lumen of the bronchioles. [ramificações finas responsáveis por conduzir o ar dentro dos pulmões]”, explains Marcelo Otsuka, coordinator of the Pediatric Infectious Diseases Committee of the Brazilian Society of Infectious Diseases.
“And the smaller the child, the greater the compromise of ventilation to be able to breathe properly.”
Premature children and children with heart or lung problems are at risk. Furthermore, in some cases there may be a genetic predisposition for more serious episodes, says the pediatric infectious disease specialist.
According to the National Institute of Health (NIH) in the United States, acute infections of the lower respiratory tract (including bronchiolitis) are among the five most common causes of death in children up to 1 year of age in the world.
But the vast majority of minors who have bronchiolitis do not even reach the emergency room and, of those who do, a small number need to be hospitalized.
But in severe cases of the disease, the worsening of the condition can be quite sudden. “The peak of greatest severity tends to be around the fifth to seventh day, but depending on the child and other associated conditions, there may be a significant worsening in the first 24 or 48 hours”, says Otsuka.
The main form of contamination is through respiratory secretions and contact, that is, children who spend the day in closed places with other people, such as daycare centers, are more prone to infection.
The peak of bronchiolitis cases in Brazil tends to be in winter, precisely because during this period people tend to be more crowded, in places with little air circulation, facilitating transmission.
“In addition, the lower temperature reduces what we call the ciliary movement of the lung, reducing the cleaning that these cilia do and favoring respiratory infections”, says Marcelo Otsuka.
Bronchiolitis: what it is, symptoms and how to treat it
In the case of babies, it is common to notice signs similar to a cold in the initial stages of bronchiolitis. These include a clear runny nose, cough, nasal obstruction, fever, irritability and difficulty eating.
In these patients, because they are very young and cannot expectorate the secretion, symptoms can progress to more intense coughing, difficulty breathing and wheezing. In these cases, the advice is to see a doctor as soon as possible.
The main sign that sounded the red alert for Francisco’s parents was the effort to expand the chest during inhalation or exhalation.
“His chest kept rising and falling in a different way. When we saw this we were already worried”, says Camille.
According to Marcelo Otsuka, this is a clear sign of respiratory difficulty and should not be ignored.
Another worrying symptom is what doctors call wishbone retraction, that is, the sinking of the neck region, just above the bone called the sternum.
Camille states that the change in Francisco’s behavior also caught the family’s attention. “He’s always very smiling, but he was downcast and apathetic,” she says.
The boy’s parents also say that the more than two weeks they spent with their son in the hospital were extremely challenging.
During the entire period he was intubated, Francisco was fed through a tube. Camille, however, continued expressing her milk to take to the hospital.
There is no treatment for the cause of bronchiolitis, so only symptomatic treatments can be carried out.
“After the diagnosis of bronchiolitis, doctors also identified a bacterial infection and he had to take antibiotics”, says Daniel. “He also had to have a blood transfusion because he was anemic.”
“It was very sad. Definitely one of the most difficult times we’ve experienced”, he says. “But we tried not to hang our heads, hoping that he would get better.”
In August, Pfizer filed a request with the National Health Surveillance Agency (Anvisa) to register the Abrysvo vaccine against respiratory syncytial virus (RSV).
The vaccine, which has already been approved in the United States, is aimed at pregnant women, offering an immune response against infections caused by the virus in newborns and babies up to six months of age.
According to Pfizer, clinical studies showed that the immunological response generated by the vaccine was capable of preventing 82% of severe forms of respiratory diseases in children up to three months old, followed by 69% up to six months old.
In Brazil, the pharmaceutical company also requested approval to protect elderly people over 60 years of age.
But even with vaccination, doctors say it is important to reinforce some measures that prevent babies from contracting the disease:
- Always wash your hands correctly when holding a baby;
- Avoid taking the baby in places with poor ventilation;
- Do not stay with the baby in places where there is tobacco smoke;
- Avoid exposing the baby to people with respiratory symptoms;
- Disinfect potentially contaminated surfaces and objects.
Francisco’s parents say they have doubled their care in this regard.
“We’ve been paying more attention to Francisco’s older brother, Bento. Whenever he comes home from school I try to give him a bath or at least wash his hands well”, says Camille.
“It was probably Bento who brought the virus into the house, but we don’t want to prevent him from having contact with his brother.”
Doctor Marcelo Otsuka also recommends keeping children well nourished and hydrated, in addition to frequently cleaning their airways, performing nasal washes and inhalation when necessary.
Babies who already have respiratory problems, such as asthma, chronic sinusitis or frequent allergies, should have regular medical monitoring.