Revised 2014 Guidelines for RSV Prphylaxis

http://aapnews.aappublications.org/content/35/8/1.1.full

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.

• Previously, prophylaxis was recommended for preterm infants born before 32 weeks’ gestation. Infants with certain risk factors born at 32 weeks, 0 days to 34 weeks, 6 days also were eligible.

In the first year of life, palivizumab prophylaxis is recommended for preterm infants born before 32 weeks, 0 days’ gestation with chronic lung disease of prematurity defined as greater than 21% oxygen for at least 28 days after birth.

• Previously, no definition of chronic lung disease was provided.

Clinicians may administer palivizumab prophylaxis in the first year of life to certain infants with hemodynamically significant heart disease. In addition, consultation with a cardiologist for decisions about prophylaxis is recommended for patients with cyanotic heart disease.

• Previously, prophylaxis also was recommended in the second year of life for certain infants with hemodynamically significant heart disease.

Clinicians may administer up to a maximum of five monthly doses of palivizumab during the RSV season to infants who qualify for prophylaxis in the first year of life (including those in Florida). Qualifying infants born during the RSV season will require fewer doses. For example, infants born in January would receive their last dose in March.

• Previously, fewer than five monthly doses were recommended for some infants.

Palivizumab prophylaxis is not recommended in the second year of life except for children who require at least 28 days of supplemental oxygen after birth and who continue to require medical intervention (supplemental oxygen, chronic corticosteroid or diuretic therapy).

• Previously, two seasons of prophylaxis were recommended.

Monthly prophylaxis should be discontinued in any child who experiences a breakthrough RSV hospitalization.

• Previously, continued prophylaxis was recommended in a child who experienced a breakthrough RSV hospitalization.

Children with pulmonary abnormality or neuromuscular disease that impairs the ability to clear secretions from the lower airways may be considered for prophylaxis in the first year of life.

• Previous recommendation was for two years of prophylaxis.

Children younger than 24 months of age who will be profoundly immunocompromised during the RSV season may be considered for prophylaxis.

• Similar to previous recommendation.

Insufficient data are available to recommend palivizumab prophylaxis routinely for children with cystic fibrosis or Down syndrome.

• Previously, the recommendation for children with cystic fibrosis was similar; children with Down syndrome were not addressed.

The burden of RSV disease in certain remote areas may result in a broader use of palivizumab for RSV prevention in Alaska Native populations and possibly in other selected Native American populations.

• Present recommendations allow for greater flexibility for Alaska Native and Native American populations.

Palivizumab prophylaxis is not recommended for prevention of RSV nosocomial disease.