Deborah Lehman, MD reviewing Farber HJ et al. Pediatrics 2016 Jul 18.

This study supports the American Academy of Pediatrics more restrictive guidelines for use.

Palivizumab (Synagis) is licensed for prevention of respiratory syncytial virus (RSV) infection in high-risk infants. The American Academy of Pediatrics (AAP) initially recommended its use for all premature infants born at or before 32 weeks gestational age and for high-risk infants born between 32 and 36 weeks. In 2014, based on a cost-benefit analysis, the AAP issued controversial new guidelines, restricting palivizumab use to otherwise healthy premature infants born at or before 29 weeks (NEJM Journal Watch Pediatr Adolesc Med Sep 2014 and Pediatrics 2014; 134:415).

In this retrospective study from nine Texas Medicaid managed care health programs, researchers assessed the consequences of less restrictive guidelines over three RSV seasons. The study included 2031 healthy infants born at 29 to 32 weeks gestational age and 12,066 born at 33 to 36 weeks. Nine percent of infants received at least one dose of palivizumab (41.5% of the younger group, 3.7% of the older group).

Overall, 4.2% of infants in each gestational age group were hospitalized with an RSV diagnosis. In the younger group, the RSV hospitalization rate was lower among infants who received at least one dose of palivizumab than in those who had not (3.1% vs. 5.0%). A total of 2.3% of infants were hospitalized with non-RSV bronchiolitis, and in the younger group, the rate was higher in those who had received palivizumab (3.3% vs. 1.9%). Receipt of palivizumab had no effect on RSV or non-RSV hospitalization rates in the older group.

CITATION(S):

Farber HJ et al. Observed effectiveness of palivizumab for 29–36-week gestation infants. Pediatrics 2016 Jul 18; 138:e20160627.

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