Their preemie was already a fighter. Then at 3 weeks she got RSV. – Orange County Register

As Abhishesh Pokharel took his 3-week-old daughter to the emergency room, her fingers and toes turned blue.

Other parts of his little body were yellow.

Something was seriously wrong.

The Greater Baltimore Medical Center triage nurse knew that too. She glanced at little Ayra and gave her father an order:

To run!

Through the building, he sped, his wife right behind him — toward the pediatric emergency department.

By then Ayra would sometimes not breathe at all, clinicians later told CNN.

The rapid response team got to work.

Still, “she wouldn’t respond to anything they did,” Pokharel recalls.

“My mind just froze and thought maybe I wouldn’t get her back.”

Ayra – born premature at just 36 weeks and 6 days – had already proven herself to be a fighter: her first day on Earth was spent in NICU due to fluid in her lungs.

Since then, she has been in good health, her father said.

But now her frail body was giving in to one of the many respiratory illnesses spreading across the United States: respiratory syncytial virus, or RSV, which is often most severe in young children and older adults.

While for the most part it causes a mild illness that can be managed at home, RSV – alongside influenza, the coronavirus that causes Covid-19 and other common respiratory viruses – has led to increased hospitalizations across the country. the country. And children’s hospitals are feeling the pressure, with more than three quarters of their hospital and intensive care beds occupied in recent months.

More than half of US states are reporting high or very high respiratory disease activity, and US officials are pleading with people, including children, to get flu shots and Covid boosters before Thanksgiving.

But for RSV, there is not yet a vaccine, nor an antiviral or specific treatment.

As baby Ayra’s blood oxygen level hit 55% – nowhere near 95% or better than it should be – her parents could only watch with tears in their eyes as they heard clinicians say their newborn unresponsive.

“I was lost,” recalls Ayra’s mother, Menuka KC. “It was a nightmare.”

Pediatric emergency staff in Towson, Maryland, were already overwhelmed with a crush of respiratory illnesses so severe they had for weeks claimed virtually every pediatric intensive care bed in the state.

But as Ayra stood before them, they knew they had to act.

Quick.

From a runny nose to a ventilator in just days

Knowing that Ayra might have gone into respiratory arrest right there in the waiting room “made us all feel heart palpitations,” said Dr. Theresa Nguyen, the center’s acting chair of pediatrics.

The infant was lethargic, breathing rapidly – ​​sometimes not breathing at all. Thick mucus filled his nose and traveled down to his lungs, Nguyen said.

His prematurity “increased his risk of his body reacting to the RSV virus”, explained the doctor.

It had only been 10 days since Pokharel’s eldest daughter, Aavya, 4, fell ill with a fever and a runny nose that her pediatrician had diagnosed as viral and ear infections, their father said. .

Five days later, on October 13, the couple noticed Ayra was starting to have a runny nose and mucus which they had to remove with a suction ball, Pokharel said. They took her to her doctor for a scheduled checkup and she was told she had a viral infection, although her lungs were clear and she had no fever.

But watch her, they were told.

Three days later, they took Ayra back because she had a bad cough, and the couple could barely hear her cry.

Two days later they were in the pediatric ER, with doctors now telling them that intubation was Ayra’s best bet.

Inserting a tube into Ayra’s airway and attaching a breathing machine would give the infant the oxygen he needed, the doctors explained.

Ayra was about to die.

She needed to be intubated immediately, doctors said, before she stopped breathing.

Her parents waited just outside the room and prayed for God to save her and bring her back to them as the medical team carefully and quickly intubated Ayra.

Immediately, his blood oxygen bounced back to a safer level.

But other obstacles awaited us.

Looking for a place for a baby to try to heal

Greater Baltimore Medical Center couldn’t keep Ayra — or any intubated child who needs to be on a ventilator — because that level of care requires a pediatric intensive care unit, Nguyen said.

The discussion quickly turned to where to send him for further care.

Hospital staff picked up the phones.

Sending patients to other facilities for treatment is common during the height of flu and RSV seasons, Nguyen said.

But this year, the need had started to increase much earlier.

Last month, Greater Baltimore Medical Center had to transfer twice as many pediatric patients as it did last October, according to hospital data. And October transfers were double what they were in September, with respiratory transfers accounting for 80%.

“My doctors see patients in the hallways every day,” Nguyen said, adding that some waited until 4 p.m. to be seen.

And it was far from the only facility squeezed by the surge in respiratory illnesses among children.

“There have been no pediatric intensive care beds available in the state of Maryland since mid-September,” Nguyen said. “We had to send kids out of state.”

Looking for a landing spot for Ayra, they called hospitals in Washington, DC, as well as Virginia and Delaware, Pokharel said.

“‘At worst, we have to airlift her and take her to another state,'” he recalled a clinician telling him as they called facilities as far apart as Georgia and Florida.

It didn’t even occur to Pokharel to think about how her family would get to where Ayra would be sent.

She needed care, no matter where.

An hour passed.

Then, a simple phone call changed everything.

Keeping vigilant as she fights for every breath

“There was a bed available,” Pokharel said, “at DC’s National Children’s Hospital.”

Ayra was transferred to an ambulance, her father seated next to the driver. Pokharel stayed the night with his sick daughter.

The next morning, KC was rushed 90 minutes from Perry Hall, Maryland, to the hospital by Pokharel’s brother, who was also caring for Aavya while the girls’ parents focused on her sick sibling.

In pediatric intensive care, Ayra lay on a tiny heated hospital bed. She was hooked up to blue and white ventilation tubes, her tiny feet and wrists restrained so she wouldn’t pull on anything. Doctors extracted fluid from his lungs and gave him an antibiotic, his father said.

During each of the next two days, Pokharel’s brother drove his sister-in-law to her house and then brought her back to her wake at Ayra’s bed.

All the while, their little fighter was fighting for every breath.

Her parents didn’t know how long they would have to wait.

Then, on the third day: a breakthrough.

Less mucus was filling Ayra’s lungs and she was getting minimal ventilator support, Pokharel said. So the doctors extubated her.

She still needed a CPAP machine — the kind adults sometimes use to treat sleep apnea — to get enough oxygen, her father said. And later, she would need a nasal cannula – the tube fitted with pins going into the nostrils – to help deliver lower amounts of oxygen.

But Ayra pulled through.

Even when the doctors started talking about getting her out, KC got nervous and started checking and rechecking to make sure her daughter was breathing.

Soon, however, Ayra’s fever subsided and she started drinking from a bottle again.

On the fourth day, a friend drove KC to see Ayra – and the whole family drove home together.

Stay isolated to protect your baby

Being back home was an adjustment.

The family of four is self-isolating until Ayra is at least 2 months old, said Pokharel, who works a hybrid schedule and runs errands.

“We have not allowed any visitors to come home,” he said. “My wife has not left the house since. She doesn’t want to go anywhere.

They also removed Aavya from daycare, hoping to keep germs at bay – and pose an extra challenge for everyone.

“We have a baby who is sick, he has just been discharged from the hospital. We are 100% focused on the little one,” Pokharel said. “And on the other hand, I have a 4-year-old who needs my attention, like, 24/7.”

Pokharel, while working a few days from home, gives Aavya pre-K notebooks so she can draw, trace or paint, he said. When he’s not at work, they go for a walk or ride their bikes.

KC spends her days taking care of Ayra. Sleep, she says, comes in periods of two or three hours.

Back at Greater Baltimore Medical Center, the crowd of children with severe respiratory symptoms continues to pour in, Nguyen said. “Our staff, our doctors, our advanced practitioners and our nursing staff are, for lack of a better word, they are overwhelmed.”

“They’re exhausted because it’s been going on for two months,” the doctor said. “And there’s no end in the near future because… you start seeing RSV and then you see the flu,” which can last until April.

“It’s really the kid’s version of the adult Covid crisis,” Nguyen said. “I don’t think he’s gotten as much attention as he needs because they’re children, they’re small. It’s the pediatricians who stand up for them, but we’re actually very, very busy with ourselves. take care of children.

As Ayra’s parents watch over their little fighter at home, they want other families to know: with this virus continuing to increase, be prepared for anything.

“I didn’t think RSV would go this far,” his father said. “I never thought I would see an intubated baby – and not my intubated baby.”

“I’m glad she’s fine and eating and sleeping well,” her mother added. “Thank you to all those doctors and nurses who saved his life.”