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RSV-related hospitalization rates appear independent of gestational age
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NEW YORK CITY — Babies born at late preterm — 34 to 36 weeks gestational age — are three times as likely to die in the first year of life than are infants born full term, according to a presentation by Michael Forbes, MD, FAAP (CCM), at the 23rd Annual Infectious Diseases in Children Symposium in New York.
For 25 years, the number of preterm infants born in the United States has remained consistent, but the number of preterm survivors has increased because of superb neonatal care and advances in reproductive technology, according to Forbes, who is director of clinical research and outcomes analysis in the department of pediatric critical care medicine at Akron Children’s Hospital in Ohio.
There are common delusions about premature infants, Forbes said. The first is that after infants leave the neonatal ICU, they are similar to full-term infants. The second is that the lung function in a “healthy late preterm infant” is comparable to term infants. Last, there is confusion about hospitalization and mortality related to respiratory syncytial virus (RSV).
“RSV-related hospitalization appears independent of gestational age,” Forbes said. “But unlike hospitalization rate, degree of prematurity is associated with increased risk of RSV-associated death. Infants born at less than 32 weeks gestational age have a 17 times higher risk of death from RSV than do infants born to term.”
The 2006 AAP guidelines to RSV prophylaxis with palivizumab (Synagis, MedImmune) recommend that infants born at 32 to 35 weeks gestational age (late preterm) should receive palivizumab if aged younger than 6 months at start of RSV season and they have two risk factors present. In 2009, the AAP changed its definition of 32 to 35 weeks gestational age to 32 weeks, 0 days through 34 weeks, 6 days. The high-risk period was reduced from 6 months to 3 months, making three doses of palivizumab the maximum instead of five doses in selected populations.
The 2009 guidelines allow infants younger than 24 months with chronic lung disease or hemodynamically significant congenital heart disease to receive five doses of palivizumab. Also, infants born at less than 31 weeks, 6 days gestational age and infants with neuromuscular disease or congenital airway anomaly can receive five doses. Infants born at 32 weeks, 0 days or later must have one risk factor plus be born within 3 months or during the RSV season to receive only three doses.
For more information:
- Forbes M. Interpreting The American Academy of Pediatrics Modified Guidelines on RSV Immunoprophylaxis. Presented at: the 23rd Annual Infectious Diseases in Children Symposium; Nov. 20-21, 2010; New York City.
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