Neo-Peds RTs: Are New RSV Immunoprophylaxis Recommendations Valid?

 Updated: July 6, 2016

RSV Immunoprophylaxis Recommendations
RSV Immunoprophylaxis: Who Should Get It And When?

Respiratory therapists specializing in neonatal-pediatrics know preterm infants are considered at higher risk for the respiratory syncytial virus (RSV), but which infants face the highest risk and thus may be candidates for treatment with RSV immunoprophylaxis (RSV IP) has been up for debate.

According to the American Academy of Pediatrics Committee on Infectious Diseases (COID), RSV IP should definitely be used for infants with chronic lung disease of prematurity (CLDP) and hemodynamically significant congenital heart disease(HS-CHD). RSV IP has been recommended for other preterm infants considered at high risk as well, such as those under 32 wGA and those 32-34 wGA attending daycare or with preschool siblings.

In 2014, however, COID back tracked on the latter recommendations, stating that RSV IP should not be used for preterm infants born at 29-35 wGA who do not have a qualifying medical condition such as CLDP or HS-CHD.

A new study in the May edition of the American Journal of Perinatology suggests the recommendations may be misguided. U.S. researchers looked at preterm infants born at 29-35 wGA who were not receiving RSV immunoprophylaxis and were hospitalized for laboratory-confirmed RSV disease before they were one year old during the 2014 to 2015 RSV season. Among the results —

  • 42% of the 702 infants in the study were admitted to the ICU and 20% required invasive mechanical ventilation (IMV).
  • Earlier gestational age and younger chronologic age were associated with an increased frequency of RSV-confirmed hospitalization (RSVH), ICU admission, and IMV.
  • Among infants 29-32 wGA and under three months of age, 68% required ICU admission and 44% required IMV.
  • One death occurred in a 29 wGA infant.

An in-depth analysis of 212 infants found mean and median RSVH charges of $55,551 and $27,461, respectively. About 63% of the infants required outpatient visits one month before being hospitalized, and 62% required outpatient visits within one month of discharge.

“Substantial morbidity and costs were identified among preterm infants 29 to 34 wGA not receiving RSV IP based on the 2014 COID guidance but who would have previously been recommended for RSV IP according to the 2009 and 2012 COID guidances,” conclude the investigators. “Preventing severe RSV disease in this population would provide substantial health benefits, particularly during the first months of life when RSV disease incidence and severity are highest.”