Nurse’s baby boy “was struggling to breathe”

By Maureen Gilmer, IU Health senior writer, mgilmer1@iuhealth.org

Logan Rabensteine had a rough start in life. Born nine weeks early at Riley Hospital for Children in June, he lost his twin brother, Benjamin, shortly after birth.

Logan spent two months in the NICU at Riley, before going home with mom and dad, Jena and Lee Rabensteine, to join his three older brothers, ages 2, 4 and 6.

But he would return to Riley barely six weeks later with a scary case of RSV – respiratory syncytial virus – which is being diagnosed in extraordinarily high numbers around the country, putting a strain on pediatric hospitals.

Normally, RSV peaks in January and February, but it has spiked early this fall.

Dr. John Christenson, associate medical director of infection prevention at Riley Children’s Health, has reported a surge in respiratory viral activity in the past month in the emergency department, about triple the number normal for this time of year. Many patients have required oxygen support, so they have been admitted for treatment.

STRUGGLING TO BREATHE

Jena, a paramedic and emergency department nurse at Eskenazi Hospital, said Logan’s case started with a slight cough on a Sunday night last month. Her older boys had already contracted the virus, so she knew Logan, still a newborn, would be especially vulnerable.

“He got sick the first weekend of October,” Jena said. “I was hoping he would dodge it, but by Sunday night, he started to cough. It progressed quickly.”

By Monday morning when her husband handed the baby to her so he could get ready for work, she knew immediately that her son needed expert care.

“He was struggling to breathe, he had chest retraction, and he was grunting,” Jena said. “I didn’t see any signs of cyanosis (blue coloring), but he was working hard.”

She suctioned his nose with a bulb syringe as much as she could before deciding she would take him to Riley instead of calling an ambulance.

Estimating the trip from the family’s New Palestine home would take 25 to 30 minutes, she didn’t account for a highway accident that stalled traffic for another 30 minutes.

In that time, she listened intently to her infant son’s breathing in his car seat while she sat in traffic.

MOM AND BABY IN DISTRESS

“He was wheezing and grunting. I started counting his respirations because he was breathing so fast, then he would have periods of apnea where he stopped breathing for up to 10 to 12 seconds.”

Close to panic, she debated calling for an ambulance right there on the highway, but about that time, traffic began moving again, and when she reached the Riley emergency department at about 8 that Monday morning, she was relieved to see only one other patient waiting.

For a Monday morning, that was a rare sight, as many emergency rooms have been overwhelmed with pediatric patients suffering from RSV or related respiratory illnesses.

Logan tested negative for Covid-19 but positive for RSV and was admitted to Riley because he wasn’t eating and was suffering periods of apnea. He was put on a nasal canula to help him breathe and an NG tube for nutrition, but he did not need to be on a ventilator.

Back home now after five days at Riley, Logan is healthy again and getting chubby, his mom said.

She’s had her hands full with all four boys as they fought off the virus. The oldest boy had pneumonia, and the second oldest got an ear infection, while the 2-year-old also took a trip to the hospital, but he was discharged after receiving a breathing treatment.

LOOK FOR THESE SIGNS

As a healthcare professional, Jena knows what to look for when deciding whether to take one of her children to the ER. She wanted to share her story to help other parents and caregivers recognize the signs of distress.

“You really need to monitor them closely and look out for signs of respiratory distress,” she said, “even rapid breathing or if they’re in a sniffing position, meaning they’re holding their chin up trying to open their airway a little more or pushing out their tongue, which Logan was doing.”

Another sign to look for is chest retraction, she said, where the chest appears to sink in around the ribs as the child breathes. Grunting and periods of apnea are also key indicators.

“Children will compensate for a long time, but when they’re crashing, they crash very quickly,” Jena said, “so it’s important to recognize it and either take them to be seen or call 911.”

This is not the family’s first go-round with RSV, but it’s definitely worse this year, she said.

“I don’t know what it is about this strain, but it is knocking them off their feet.”

She offers some advice for keeping kids safe this time of year, starting with avoiding large groups of people.

“Be very careful with who the baby is around. Especially with Logan, we’re keeping him sheltered. It’s just not worth it. It’s too dangerous.”

She and her husband are reminding their older kids to wash their hands as often as possible, not an easy task when you’re dealing with toddlers.

Pfizer recently announced that its maternal RSV vaccine in development reduced the rate of severe illness in newborns by 81.8%. By giving the vaccine during pregnancy, researchers anticipate that antibodies generated by mothers will transfer to infants. The company plans to file data on the vaccine with regulators by the end of the year.