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Impact of respiratory syncytial virus immune globulin in 1996-1997: a local controlled comparison
G J Redding1, S Braun, D Mayock
1Department of Pediatrics, University of Washington School of Medicine, Seattle, USA.
Insights
Respiratory syncytial virus (RSV) immune globulin did not significantly reduce hospitalizations in very young infants without lung disease. Current guidelines may need refinement beyond gestational age for RSV prevention in premature infants.
Area of Science:
- Pediatrics
- Infectious Diseases
- Immunology
Background:
- Respiratory syncytial virus (RSV) immune globulin is used to prevent RSV-related hospitalizations in high-risk infants.
- Current recommendations for RSV immune globulin use in specific infant populations are inconsistent.
Purpose of the Study:
- To compare RSV hospitalization rates in prematurely born infants with and without chronic lung disease who received RSV immune globulin versus those whose parents refused treatment.
- To evaluate the effectiveness of RSV immune globulin in preventing RSV-related respiratory illness hospitalizations.
Main Methods:
- Inception cohort study design.
- Participants included infants born at <35 weeks gestation (<6 months old, no lung disease) and premature infants (<2 years old) with chronic respiratory disease.
- Main outcome measure was hospitalization for an RSV-related respiratory illness.
Main Results:
- Of 76 treated infants, 3 (4%) were hospitalized for RSV; of 65 untreated infants, 2 (3%) were hospitalized.
- Among infants with chronic lung disease, 5% of treated and 11% of untreated infants were hospitalized.
- No hospitalized infants were observed among those born prematurely without lung disease, whether treated (0/10) or untreated (0/47).
Conclusions:
- Hospitalization risk for RSV is low in premature infants <6 months old without lung disease.
- Current RSV immune globulin recommendations for preventing RSV illness in this group may need to incorporate specific clinical factors beyond gestational age.
Background:
Immune globulin containing high titers of neutralizing antibodies specific for respiratory syncytial virus (RSV) is clinically used to prevent hospitalizations for RSV-related respiratory infections among high-risk infants. However, recommendations regarding which patient populations should receive RSV immune globulin are inconsistent.
Objective:
To compare hospitalization rates for prematurely born infants with and without chronic lung disease who received RSV immune globulin with similar infants whose parents refused such treatment during the 1996-1997 winter season.
Design:
Inception cohort study.
Participants:
Infants born at less than 35 weeks' gestation and less than 6 months old without lung disease and children who had been born prematurely, had chronic respiratory disease, and were less than 2 years old at the onset of the RSV season.
Main Outcome Measure:
Hospitalization for an RSV-related respiratory illness.
Results:
Seventy-six infants (66 [87%] with chronic lung disease and 10 [13%] born prematurely without lung disease) received RSV immune globulin; 65 infants (18 [28%] with chronic lung disease and 47 [72%] born prematurely without lung disease) did not. Three (4%) of the treated group and 2 (3%) of the untreated group were hospitalized for RSV infections. Of those with chronic lung disease, 5% (3/66) of those treated with RSV immune globulin were hospitalized, compared with 11% (2/18) of those untreated. Of those born prematurely without lung disease, no infant in the treated (0/10) or untreated (0/47) group was hospitalized.
Conclusions:
The risk of hospitalization of infants born prematurely who are younger than 6 months without lung disease is low. Current recommendations for preventing RSV illness in this group by using RSV immune globulin may require inclusion of more specific clinical characteristics rather than gestational age alone.