Preparing for Discharge During RSV Season
By Ashley Richardson, MSN RNC-NIC
As a neonatal intensive care nurse, what do you say to the average NICU patient’s family as you prepare them for discharge during respiratory syncytial virus (RSV) season? Is there a conversation that specifically explains RSV season and precautions—or does that only occur when it is geared toward the family of a patient who qualifies for RSV medication prophylaxis?
It is important to understand what RSV is, what it does and how we protect the vulnerable NICU population, specifically with the lens of discharging during RSV season.
Respiratory Syncytial Virus: What Is It?
RSV is an RNA virus that infects respiratory epithelial cells and is spread by direct contact or through large respiratory droplets (Jha et al., 2016). The virus gets its name syncytial from the word syncytia, the large multinucleated result of cells fusing due to RSV (Jha et al., 2016). RSV is one of the most common causes of lower respiratory tract infections and respiratory related hospitalizations (Rezaee et al., 2017).
When the virus replicates in the body, it causes sloughing of the epithelium in the bronchioles, overproduction and secretion of mucus, and severe edema. Initial symptoms are manifested as runny nose, coughing, and sneezing and then progressing to increasing respiratory distress and wheezing as it moves into the lower respiratory tract (Schrand et al., 2001). RSV is common among adults who are not likely to be severely affected by the symptoms and sequelae. However, those with lower reserve and immature immune symptoms can severely be impacted, leading to hospitalization and need for extreme interventions.
Healthcare Burden and Prophylaxis
Though nurses do not focus on the cost of health care while caring for their patients, it is important to understand the burden of disease in conjunction with the cost. We care for our patients regardless of their ability to pay but should also pay attention to what is happening in health care so we can better prepare ourselves and our patients’ families.
An article published in 2024 estimated the cost of RSV hospitalizations in the United States at around $472 million per year (Hutton et al., 2024)—and these are not just NICU babies who are being readmitted with complications of RSV.
RSV hospitalizations cannot be eliminated, but what can be done to ease that burden with better prevention?
Are you aware of your current RSV prophylaxis algorithm and treatment regimen for high-risk infants being discharged during the fall and winter seasons?
RSV prophylaxis with palivizumab (Synagis®) was approved by the U.S. Food and Drug Administration (FDA) in June of 1998 (Romero, 2003). Those who qualified (usually less than 29 weeks gestation, with a chronic lung disease diagnosis or hemodynamically significant congenital heart disease) were started on a monthly regimen of injections. This monthly requirement was due to the short half-life (20 days) of palivizumab (Rago et al., 2024). This was the standard prophylaxis treatment but presented a few hurdles for the families post discharge. Some families started the regimen but did not complete the full 5-month treatment due to not fully understanding its importance or not having access to care (e.g. transportation to clinics to receive injections) (Rago et al., 2024).
Thankfully, new medications have been introduced in the fight to prevent RSV. There are now two long-acting monoclonal antibody products available. Clesrovimab (Enflonsia™) was approved this year, and Nirsevimab (Beyfortus®) was introduced in 2023 (Rago et al., 2024). These new medications have a 60-day half-life so infants can receive one injection as prophylaxis.
Maternal RSV vaccine administration given at 24-36 weeks of pregnancy and at least 4 weeks prior to delivery is another path toward prevention (Zar, 2025).
The newer drugs’ effectiveness over two RSV seasons with the newer drugs have led to the discontinuation of Synagis, which will no longer be available after December 31, 2025.
Most institutions have continued the same requirements for administration of newer RSV prophylactic drugs that were in place for Synagis, but it is possible administration eventually may be given to healthy infants born during RSV season or other infants who do not qualify under current guidelines (Hsiao et al., 2025).
The cost of administering these medications is high, but the cost of hospitalizing and treating these infants when they have RSV is even higher. The lower healthcare costs and reduced burden on an already stressed and stretched healthcare system seems worth the investment in preventative drug administration.
Discharge Education
In your unit, do all families discharged during RSV season get the same education about what RSV is, what it does, and how to prevent it? Not all babies receive prophylaxis treatment even when discharged during RSV season, so should all education be the same?
Whether your patient is in the NICU for a few days or a few months, the standard infection control measures families have been educated on throughout their stay are the same safety measures that keep their NICU baby safe at home, such as good hand hygiene, routinely disinfection of shared spaces and surfaces, and staying away from those who are sick (Krause, 2018).
Should RSV discharge education be geared toward all babies discharged during RSV season or only high-risk infants? Will there be a shift in how we prepare all babies—regardless of their risk—to be discharged home when RSV prophylaxis medication is widely administered?
All families should be made aware of the risk, but it is key that we give proper education without creating unnecessary panic when discharging in the fall and winter.
References
Griffin, M. P., Yuan, Y., Takas, T., Domachowske, J. B., Madhi, S. A., Manzoni, P., Simões, E. A. F., Esser, M. T., Khan, A. A., Dubovsky, F., Villafana, T., DeVincenzo, J. P., & Nirsevimab Study Group (2020). Single-dose nirsevimab for prevention of RSV in preterm infants. The New England Journal of Medicine, 383(5), 415–425. https://www.doi.org/10.1056/NEJMoa1913556
Hsiao, A., Hansen, J., Fireman, B., Timbol, J., Zerbo, O., Mari, K., Rizzo, C., La Via, W., Izikson, R., & Klein, N. P. (2025). Effectiveness of nirsevimab against RSV and RSV-related events in infants. Pediatrics, 156(2), e2024069510. https://doi.org/10.1542/peds.2024-069510
Hutton, D. W., Prosser, L. A., Rose, A. M., Mercon, K., Ortega-Sanchez, I. R., Leidner, A. J., McMorrow, M. L., Fleming-Dutra, K. E., Prill, M. M., Pike, J., & Jones, J. M. (2024). Cost-effectiveness of nirsevimab for respiratory syncytial virus in infants and young children. Pediatrics, 154(6), e2024066461. https://doi.org/10.1542/peds.2024-066461
Jha, A., Jarvis, H., Fraser, C., & Openshaw, P. J. M. (2016). Respiratory syncytial virus. In D. S. Hui (Eds.) et. al., SARS, MERS and other Viral Lung Infections. European Respiratory Society.
Krause, C. I. (2018) The ABCs of RSV. The Nurse Practitioner, 43(9) 20–26. https://doi.org/10.1097/01.NPR.0000544277.74514.55
Rago, A. R. P., D’Arrigo, S. F., Osmani, M., Espinosa, C. M., & Torres, C. M. (2024). Respiratory syncytial virus: Epidemiology, burden of disease, and clinical update. Advances in Pediatrics, 71(1), 107–118. https://doi.org/10.1016/j.yapd.2024.02.003
Rezaee, F., Linfield, D. T., Harford, T. J., & Piedimonte, G. (2017). Ongoing developments in RSV prophylaxis: a clinician’s analysis. Current Opinion in Virology, 24, 70–78. https://doi.org/10.1016/j.coviro.2017.03.015
Romero J. R. (2003). Palivizumab prophylaxis of respiratory syncytial virus disease from 1998 to 2002: results from four years of palivizumab usage. The Pediatric Infectious Disease Journal, 22(2 Suppl), S46–S54. https://doi.org/10.1097/01.inf.0000053885.34703.84
Schrand, L. M., Elliott, J. M., Ross, M. B., Bell, E. F., & Mutnick, A. H. (2001). A cost-benefit analysis of RSV prophylaxis in high-risk infants. The Annals of Pharmacotherapy, 35(10), 1186–1193. https://doi.org/10.1345/aph.10374
Zar, H. J. (2025). New advances in RSV: Is prevention attainable?. Pediatric Pulmonology, 60(Suppl 1), S120–S122. https://doi.org/10.1002/ppul.27310