Originally posted 2016-09-19 20:47:16.
Georgia AAP Communication
September 19, 2016
Guidance for Palivizumab Prophylaxis among Infants and Young Children at Increased Risk of Hospitalization for Respiratory Syncytial Virus Infection
Technical report: www.pediatrics.org/cgi/doi/10.
The AAP recommends use of palivizumab be limited to high-risk infants who are most likely to benefit:
- Infants born before 29 weeks gestation;
- Infants with certain chronic illnesses, including congenital heart disease or chronic lung disease.
Summary of Guidance
- In the first year of life, palivizumab prophylaxis is recommended for infants born before 29 weeks, 0 days’ gestation.
- Palivizumab prophylaxis is not recommended for otherwise healthy infants born at or after 29 weeks, 0 days’ gestation.
- In the first year of life, palivizumab prophylaxis is recommended for preterm infants with CLD of prematurity, defined as birth at <32 weeks, 0 days ‘gestation and a requirement for >21% oxygen for at least 28 days after birth.
- Clinicians may administer palivizumab prophylaxis in the first year of life to certain infants with hemodynamically significant heart disease. Decisions regarding palivizumab prophylaxis for infants with heart disease may be made in consultation with a pediatric cardiologist.
- Clinicians may administer up to a maximum of 5 monthly doses of palivizumab (15 mg/kg per dose) during the RSV season to infants who qualify for prophylaxis in the first year of life. Qualifying infants born during the RSV season may require fewer doses.
- Palivizumab prophylaxis is not recommended in the second year of life except for children who required at least 28 days of supplemental oxygen after birth and who continue to require medical intervention (supplemental oxygen, chronic corticosteroid, or diuretic therapy).
- Monthly prophylaxis should be discontinued in any child who experiences a breakthrough RSV hospitalization.
- Children with pulmonary abnormality or neuromuscular disease that impairs the ability to clear secretions from the upper airways may be considered for prophylaxis in the first year of life.
- Children younger than 24 months who will be profoundly immunocompromised during the RSV season may be considered for prophylaxis.
- Insufficient data are available to recommend palivizumab prophylaxis for children with cystic fibrosis or Down syndrome.
- The burden of RSV disease and costs associated with transport from remote locations may result in a broader use of palivizumab for RSV prevention in Alaska Native populations and possibly in selected other American Indian populations.
- Palivizumab prophylaxis is not recommended for prevention of health care-associated RSV disease.
Copyright 2017 Michael Nwaneri