Guidelines for palivizumab prophylaxis: are they based on infant's risk of hospitalization for respiratory syncytial viral disease?

Background. The American Academy of Pediatrics (AAP) guidelines for respiratory syncytial virus (RSV) prophylaxis aim to prioritize palivizumab administration to infants at highest risk for RSV disease. Multiple studies have been published that assess the risk of hospitalization for RSV disease by gestational age (GA) at birth and severity of lung disease. Objective. To evaluate whether the AAP guidelines for RSV prophylaxis correlate with the available data in the literature on the degree of risk of hospitalization for RSV disease by GA at birth and severity of lung disease. Methods. We considered a hypothetical population of infants with and without chronic lung disease. This population was then divided into hypothetical cohorts depending on GA at birth and month of neonatal intensive care unit discharge. We assumed that infants are discharged from neonatal intensive care unit at 36 to 37 weeks postconceptional age. By applying the AAP policy for RSV prophylaxis, the numbers of palivizumab injections were determined for the different cohorts. Results. In some instances infants who are currently known to be at higher risk of hospitalization for RSV disease receive fewer palivizumab injections than infants known to be at lower risk. Conclusion. Some discrepancies exist between the RSV prophylaxis guidelines and the published data on the level of risk of hospitalization for RSV disease by GA and lung disease. AAP policy for RSV prophylaxis must be amended to better correlate the amount of palivizumab prophylaxis with the level of risk of hospitalization for RSV disease as determined by the above factors.