BACKGROUND: The American Academy of Pediatrics recommends palivizumab prophylaxis against respiratory syncytial virus (RSV) for infants at high risk for severe disease within 72 hours of hospital discharge to prevent community-associated RSV. The American Academy of Pediatrics does not recommend palivizumab to prevent health care–associated RSV (HA-RSV).
METHODS: A retrospective, multicenter cohort of hospitalized infants who received nondischarge palivizumab (NDP) between January 2009 and December 2013 was established from 14 hospitals. NDP was defined as a charge for palivizumab >7 days before hospital discharge and no previous documented RSV. Infants were considered high risk for severe disease if they had chronic lung disease, chronic heart disease, or prematurity. Nondischarge palivizumab use was examined for high- and low-risk infants. HA-RSV was defined as an RSV-positive test (polymerase chain reaction, enzyme immunoassays, or culture) >3 days after admission and the frequency was measured for infants who did and did not receive NDP.
RESULTS: We identified 1263 patients who received at least 1 dose of NDP, most of whom were classified as high risk (80%). Among high-risk patients, the predictors of receipt of NDP included longer length of stay, institution, and no comorbid conditions. Most of the low-risk patients (88%) who received NDP had no comorbid conditions. NDP use varied widely among institutions. Overall, 25 eligible patients developed HA-RSV; 17 of whom received NDP.
CONCLUSIONS: Despite current recommendations, palivizumab for prevention of HA-RSV was common, even among patients at low risk of severe RSV.
- American Academy of Pediatrics
- congenital heart disease
- chronic lung disease
- health care–associated respiratory syncytial virus
- International Classification of Diseases, Ninth Revision, Clinical Modification
- interquartile range
- length of stay
- nondischarge palivizumab
- presumed prophylactic palivizumab
- respiratory syncytial virus
- Copyright © 2016 by the American Academy of Pediatrics