Demographic Characteristics Associated With Uptake of Neonatal Respiratory Syncytial Virus Prophylaxis

Respiratory syncytial virus (RSV) prophylaxis, including maternal RSVPreF vaccination and infant-administered nirsevimab, was introduced in 2023 to mitigate severe RSV outcomes in neonates. This study examines the uptake of RSV prophylaxis in neonates born in a U.S. military healthcare setting, focusing on maternal and infant demographic factors and the impact of universal healthcare access.

A retrospective analysis was conducted on neonates born between October 16, 2023, and March 31, 2024, at a military treatment facility. Inclusion criteria encompassed neonates admitted to the mother-baby unit or neonatal intensive care unit, excluding those who died or were transferred before discharge. Demographic data were collected, and RSV prophylaxis rates were analyzed using descriptive statistics and chi-squared tests, with a significance threshold of P < .05.

Among 571 eligible neonates, 455 (80%) received adequate RSV prophylaxis, defined as either maternal RSVPreF administration or neonatal nirsevimab by discharge. Uptake was higher among infants of active duty/reserve/guard mothers (84%) compared to dependents/retirees (77%; P = .047). No significant differences were observed based on maternal race or rank (P = .89 and P = .45, respectively). Of the 116 infants lacking prophylaxis at discharge, 7 (6%) received nirsevimab as outpatients within 2-3 weeks postpartum, emphasizing this period as critical for intervention.

This study highlights the high uptake of RSV prophylaxis within a universal healthcare model and identifies the possibility of maternal service member status as a factor influencing uptake. The results suggest that the first month of life is a pivotal period for addressing gaps in RSV prophylaxis coverage. Although race did not significantly affect uptake, ongoing research is needed to explore barriers and refine strategies to optimize prevention efforts, particularly among dependent and retired populations. These findings underscore the role of universal health care in mitigating disparities and improving neonatal health outcomes.