Reply

Abstract

We thank Rossi et al for commenting on our study supporting adherence to the American Academy of Pediatrics (AAP) recommendations for palivizumab prophylaxis among children at ≥29 and <35 weeks gestational age at risk for respiratory syncytial virus (RSV). Rossi et al calculated the aggregate ratios of RSV-associated hospitalizations over 2 periods. We provided the number of total RSV hospitalizations as a metric for infection pressure by RSV in the community, not as a denominator. Total RSV admissions, the great majority of which are infants born at term, are declining. Using a declining denominator will always result in an increased proportion. The aggregated odds of RSV infection among children born at ≥29 and <35 weeks gestational age relative to those born at <29 weeks receiving prophylaxis (a better comparator) was not significant (P = .513). The summary Fisher exact test chosen by Rossi et al obscures yearly variation in RSV activity and associated hospitalizations. We illustrated that a simpler study involving 1 year before and 1 year after the AAP policy change would have demonstrated a deleterious effect, as others have reported. That facile conclusion was not supported by our 5-year study, the longest study reported to date. Using 1-way ANOVA across 5 RSV seasons rather than the Fisher test, there was no statistical difference for any gestational age group (<29 weeks, P = .336; ≥29 and <35 weeks gestational age, P = .161; >35 weeks, P = .883), despite the AAP policy change. Palivizumab should confer a benefit at any age. There should have been a slight increase in hospitalization following the policy change, which may have occurred. The question is whether that benefit is tangible relative to very tangible costs. There was no statistically significant increase in RSV hospitalizations in the ≥29 and <35 weeks gestational age range using linear regression (or ANOVA). The statistics cannot be softened. We predict that a much larger study with an effective drug such as palivizumab would capture a subtle benefit. More on the impact of American Academy of Pediatrics palivizumab guidance for infants with respiratory syncytial virus infectionThe Journal of PediatricsVol. 212PreviewAccording to the 2014 American Academy of Pediatrics (AAP) recommendations, preterm infants born at ≥29 weeks' gestational age (WGA) no longer qualify for palivizumab prophylaxis, unless they have additional risks.1 To evaluate the effects of this AAP restriction on respiratory syncytial virus (RSV) infections, Zembles et al2 compared data on RSV-associated hospitalizations (RSVaH) related to 2 seasons before (pre-AAP) and 3 seasons after (post-APP) the implementation of the revised recommendations. Full-Text PDF