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The impact of the recent AAP changes in palivizumab authorization on RSV-induced bronchiolitis severity and incidence

Antonino Capizzi1, Michela Silvestri1, Andrea Orsi2

  • 1Department of Pediatrics, Pulmonology and Allergy Unit and Cystic Fibrosis Center, Istituto Giannina Gaslini, Genoa, Italy.

Italian Journal of Pediatrics
|August 16, 2017
PubMed

Insights

Italian guidelines restrict palivizumab for premature infants born after 29 weeks gestational age (wGA). This study shows these infants, especially those <36 wGA needing respiratory support, are still vulnerable to RSV-induced ALRI, warranting guideline reevaluation.

Area of Science:

  • Pediatric Pulmonology
  • Infectious Diseases
  • Neonatology

Background:

  • The Italian Drug Agency (AIFA) restricted palivizumab coverage to infants <29 weeks gestational age (wGA) and ≤12 months old, based on US RSV epidemiology data.
  • Italian studies indicate that premature infants ≥29 wGA remain vulnerable to severe respiratory syncytial virus (RSV) disease.

Discussion:

  • A retrospective analysis of RSV-induced acute lower respiratory infection (ALRI) admissions (2014-2017) at Gaslini Hospital was conducted.
  • The study examined the impact of restricted palivizumab prophylaxis in premature infants during the 2016-2017 RSV season.
  • Infants <36 wGA, particularly those born at 33-35 wGA and under 6 months old, represented a significant proportion of admissions.

Key Insights:

  • Restricted palivizumab prescription was associated with a high admission rate for premature infants <36 wGA.
  • A notable number of these admitted premature infants required high-flow nasal cannula ventilation.
  • The findings highlight the continued risk of RSV-induced ALRI in premature infants ≥29 wGA, especially with specific risk factors.

Outlook:

  • Reevaluation of palivizumab prophylaxis guidelines for premature infants ≥29 wGA with identified risk factors is strongly suggested.
  • Further research should focus on refining risk stratification for RSV immunoprophylaxis in vulnerable preterm populations.
  • This study underscores the need for Italy-specific data to inform national guidelines on RSV prevention in preterm infants.

Keywords:
PalivizumabPretermProphylaxisRespiratory syncytial virus

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