Abstract
Palivizumab is the only licensed and effective immunoprophylaxis (IP) available to prevent respiratory syncytial virus (RSV) infection in high-risk infants including infants born at ≤35 weeks’ gestational age (wGA). In 2014, the American Academy of Pediatrics stopped recommending IP for otherwise healthy 29–34 wGA infants, stating that their risk of RSV hospitalization (RSVH) was similar to term infants. Recent studies have demonstrated a significant decline in IP use after 2014 that was accompanied by an increased risk of RSVH in 29–34 wGA infants vs term infants. Severity and healthcare utilization of RSVH were high among 29–34 wGA infants. In 2018, the National Perinatal Association developed guidelines advocating IP use in all ≤32 wGA infants and 32–35 wGA infants with additional risk factors. Risk factor predictive models can identify infants who are at risk for RSVH and promote cost-effective use of palivizumab until new methods of RSV prevention become available.
Highlights
Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infection (LRTI)-related hospitalizations, manifesting as bronchiolitis or pneumonia in infants aged
Boyce et al conducted a retrospective analysis of children aged
Alveolar development begins at ~30–32 weeks’ gestational age (wGA) and alveoli are not fully developed in all infants until 36 wGA [11, 12]. Preterm infants, those born before 32 wGA, have minimal maternal antibody transfer, resulting in increased susceptibility to RSV and other infections, as more than 50% of maternal antibody transfer occurs after 34 wGA [13, 14]
Summary
Respiratory syncytial virus (RSV) is the leading cause of lower respiratory tract infection (LRTI)-related hospitalizations, manifesting as bronchiolitis or pneumonia in infants aged
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