RSV is respiratory syncytial (pronounced sin-SISH-ull) virus. It is a very contagious virus that commonly gives adults and older children the common cold, especially during the winter. Any cold could be due to RSV. There is no way to know if a person's cold is due to RSV or some other virus without doing a special test. Virtually all children catch RSV at least once by the time they are three years old.

When RSV infects a very young former premature baby, it sometimes becomes a serious pneumonia that may require admission to the hospital for several days. Such a hospital admission may include being put on a ventilator. A single RSV infection may leave a baby with a lifelong wheezing problem, or at least start the first asthma attack of a child who would have otherwise developed asthma later in life. Some babies die from their RSV infections.

Previously healthy, former full term babies can also get very sick from RSV, although much less often than a former premature baby.

The old saying, "there is no cure for the common cold" is true for RSV. Once a baby has a RSV infection, all we can do is help a sick baby's breathing (if needed) and hope the baby's own immune system can fight off the RSV infection before it gets too serious.

Unfortunately, there is no vaccine to stimulate a baby's own immune system to make antibodies against RSV, as do the many "baby shots" that successfully prevent many serious diseases like pertussis (whooping cough).

We can try to keep the RSV virus away from former premature babies. Keeping babies away from people with colds is an obvious first step. Babies who go to day care centers often catch colds from the other children. Families with other young children in school face a similar problem. If you catch a cold yourself, frequent handwashing (especially just before handling either your baby or things that your baby handles) and even wearing a mask over your nose and mouth may help keep your cold from your baby, but it is difficult to keep the very contagious RSV from spreading within a household.

Immunoglobulins are the antibodies in our blood that help us fight infections. We do not have a vaccine that can stimulate a baby's immune system to make its own anti-RSV antibodies. We do, however, have the next best thing, which is the ability to give anti-RSV antibodies to babies.

Until the fall of 1998, the only way to give babies RSVIG was to give it with an IV over a few hours. Now, however, there is a much more concentrated form of RSVIG which can be given as a standard shot (intramuscular, or IM for short).

In a large research study of IM (intramuscular shot) RSVIG treatment of former premature babies, 1000 babies treated with RSVIG were compared to 500 babies not treated with RSVIG. The need for hospitalization was reduced by RSVIG treatment (see details below).

Very few babies in this study died, and there was certainly no clear effect of RSVIG on the unlikely chance of death from RSV. RSVIG treatment did not change the need for a ventilator (also called a respirator), either.

In the IM RSVIG study, 10.6 percent of the babies who were not treated with RSVIG were hospitalized with a RSV infection, while 4.8 percent of the babies who were treated with RSVIG were hospitalized with a RSV infection. So babies who were given RSVIG are still sometimes hospitalized, but only about half as much as babies who were not given RSVIG. About 17 babies must be treated to prevent one hospitalization.

In more individual terms, that means there is a one in 17 chance that your baby will be kept out of the hospital by getting these shots.

Babies who were born since the beginning of last September, were more premature at birth (especially 28 weeks or less at birth), are boys, or have bronchopulmonary dysplasia (BPD, see below) are at the greatest risk. Babies who are currently receiving any treatment for their lungs (a ventilator, nasal prong CPAP, oxygen, wheezing medications, steroids, or diuretic drugs to get water out of the body) are at particularly high risk.

The chance of your baby being exposed to someone with a cold must be considered. Smoking in the household also increases the risk of hospitalization if a baby catches RSV.

Take your baby�s original due date, then go back four weeks. If your baby was on oxygen at that time, then your baby has BPD.

Babies who were born after June 1st of this year at 35 weeks of the pregnancy or less are eligible for RSVIG treatment.

If your baby was born before June 1 of this year, but has needed some sort of lung-oriented treatment (oxygen, diuretics, bronchodilators, or steroid drugs) since June 1 of this year, then your baby is also eligible for RSVIG treatment.

No, RSVIG treatment is something you may choose or not choose for your child. While it appears clear that RSVIG keeps some babies out of the hospital, there is not yet any evidence of more important long-term benefits, such as avoiding death or long-term respiratory problems. It is also somewhat inconvenient to get this treatment.

The antibodies wear off after about a month, so the shot must be given every month through the winter months (typically November through April). The new IM shot form of RSVIG is far more convenient than the old IV form given in previous years, however.

RSVIG will generally be given in a doctor�s office, much like regular "baby shots", although other locations may be possible.

A hidden risk of RSVIG treatment is the possibility that your baby might catch a cold at the place where the treatment is given. When making your appointment and again when showing up for your appointment, ask if special arrangements can be made to keep your baby away from people who may have colds. (These precautions are a good idea for any trip to the doctor's office during your baby's first winter.)

If your baby was given RSVIG while in the hospital, you were told about it, and some of the information given here should sound familiar. In the hospital, the IV form may have been used, but even in those situations, the IM form is still probably the best choice after going home.

For many babies at relatively lower risk for hospitalization due to RSV, treatment while in the hospital, but not after discharge home, is a reasonable option. This limited approach covers the period of greatest risk (when your baby is particularly young) without the inconveniences of monthly treatments after going home.

Yes. A small percentage of babies given RSVIG will have fever, mild injection site reactions, or other problems after the RSVIG shot. When these problems occur, they are nearly always minor and don�t last very long. Severe, dangerous allergic reactions are possible, but they are very rare. (None of the 1000 treated babies in the large RSVIG study had a severe allergic reaction.)

In this area, the annual winter RSV epidemic usually begins at the end of November, increases quickly during December, peaks in January, and gradually decreases over the rest of the winter.

Therefore, for this treatment to work as well as possible, it should be started in November. It can, however, be started later.

Babies who are hospitalized in the Newborn ICU (or perhaps elsewhere) during the RSV season may start their RSVIG treatment later than November.

RSVIG is very expensive, costing hundreds of dollars per shot. Most, but not all, health insurance plans are paying for Synagis shots. You should check with your own medical coverage provider, to be sure you will not be expected to pay a very large bill by yourself.

The American Academy of Pediatrics recommends this treatment for many former premature babies, but does so with phrases like "should be considered" and "may benefit". Clearly, they were not completely convinced that RSVIG's benefits definitely exceed its disadvantages for all former premature babies.

Assuming your baby qualifies for this treatment, we do recommend it, but we also understand that declining this treatment is reasonable.

An important factor in your decision is your general feeling about new medical treatments. Some people feel compelled to use all of the latest treatments. Others are suspicious of new treatments, fearing unknown rare or future side effects. Both views are held by many reasonable and informed people.

Remember that RSVIG has only been shown to decrease the chance of a baby needing to be admitted to the hospital, and that the chance that RSVIG will indeed keep your baby out of the hospital is relatively small, (roughly one in 17, as explained above). It has not been shown to have any effect on medical problems of long-term importance.

Staying out of the hospital is still a worthwhile goal, however. Consider how a hospitalization would affect you and your family. If missing many days of work due to your baby�s hospitalization could cost you your job, for instance, that would be a very important "real-life" long-term effect of a short-term hospitalization.

Yes, there is influenza, and there is a standard type of vaccine for that, and is relatively inexpensive. If your baby is more than six months old, the influenza vaccine can be given, usually in two intramuscular shots one month apart (the first year a person gets flu shots). If your baby is not yet six months old, vaccinating everyone else in the home offers a fair degree of protection. Influenza vaccination is not required, either, but it is also recommended.

Unfortunately, most people use the phrase "the flu" very loosely. To most people, "the flu" is any virus that makes you feel lousy. Influenza is a specific virus, one that makes most people feel especially lousy. Often one hears people say the influenza vaccine "doesn't work", making statements like, "I got a flu shot last year, and I got the flu anyway." The influenza vaccine works against the influenza virus, but not against the many other viruses often called "the flu". So people often think the vaccine failed, when in fact it worked well against the true influenza virus.