Critical Case of a Preterm Infant Infected With Respiratory Syncytial Virus Managed in the Pediatric Intensive Care Unit: A Case Report

Abstract

We describe a critical case of a respiratory syncytial virus (RSV) infection in a preterm infant resulting in respiratory failure with advanced respiratory interventions and discharge from our hospital without the requirement for home oxygen therapy or tube feeding. The infant, delivered at 35 weeks gestation due to a premature rupture of the membranes with a birth weight of 2 kg, initially demonstrated a stable postnatal course. The baby required no resuscitation, with Apgar scores of 8 and 9 at one and five minutes, respectively. The infant was discharged in good condition after four days of hospitalization. This report presents a critical case of RSV infection in a preterm infant requiring intensive care. The infant, born at 35 weeks gestation, initially appeared healthy but developed severe symptoms at 22 days old. The emergency evaluation revealed significant respiratory distress and confirmed RSV pneumonia. Following extensive interventions, including mechanical ventilation to manage severe symptoms, along with complications such as pneumothorax and a cardiac arrest episode, the infant exhibited a positive response to subsequent treatments. The infant responded positively to high-frequency oscillatory ventilation and inhaled nitric oxide. Gradual weaning from advanced ventilation led to successful extubation, followed by recovery with high-flow nasal cannula therapy. The case highlights the challenges of managing severe RSV infections in preterm infants and the efficacy of intensive care interventions in facilitating the infant's remarkable recovery and discharge.

Keywords: acute bronchiolitis; high flow nasal cannula (hfnc); high-frequency oscillator ventilator (hfov); inhaled nitric oxide; non-invasive positive pressure ventilation (nippv); pediatric intensive care unit(picu); positive end-expiratory pressure (peep); pressure control ventilation method; respiratory syncytial virus (rsv); respiratory tract.

Figure 1. Chest X-rays with the right upper lobe collapse

This is a chest radiograph showing a visible opacity in the upper right lung field, indicative of a dense, collapsed area with reduced volume compared to surrounding lung regions.

Figure 2. Chest X-rays with tube insertion

This is a post-interventional chest radiograph, following intercostal tube (ICT) placement, demonstrating the re-expansion of the previously collapsed lung. However, the remaining extensive pulmonary infiltrate is indicative of persistent parenchymal disease.

Figure 3. Chest X-rays with the presence of a tension pneumothorax on the left side

This is a chest radiograph indicating the presence of a tension pneumothorax on the left side, characterized by the displacement of mediastinal structures away from the affected side, along with the collapse of the left lung and a significant pressure effect on the thoracic components.

Figure 4. Chest X-rays prior to discharge (normal lungs)

This is a radiograph showing both lung fields appearing symmetrical and clear without any visible abnormalities, indicating the restoration of normal lung architecture.