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Updated: Jan 15, 2026

Generating a Reproducible Model of Mid-Gestational Maternal Immune Activation using PolyI:C to Study Susceptibility and Resilience in Offspring
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Multicentre study on nirsevimab: Bayesian analysis reveals persisting risk for preterm infants.

Enrico Cocchi1,2, Silvia Bloise3, Aurora Lorefice4

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BMJ Paediatrics Open
|October 14, 2025
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Summary
This summary is machine-generated.

Nirsevimab significantly reduced respiratory syncytial virus (RSV) hospitalizations and severity. However, its effectiveness decreased in preterm infants, suggesting a need for adjusted dosing strategies for this vulnerable group.

Keywords:
Child HealthHealth PolicyInfantNeonatologyVirology

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Area of Science:

  • Pediatrics
  • Infectious Diseases
  • Immunology

Background:

  • Respiratory syncytial virus (RSV) is a leading cause of lower respiratory tract infections in infants.
  • Nirsevimab is a monoclonal antibody providing passive immunity against RSV.
  • The effectiveness of nirsevimab prophylaxis in relation to gestational age requires further investigation.

Purpose of the Study:

  • To evaluate the timing and effectiveness of nirsevimab prophylaxis in infants.
  • To determine if gestational age influences nirsevimab's protective effect against RSV hospitalization.
  • To assess the impact of nirsevimab on the clinical severity of RSV infections.

Main Methods:

  • Retrospective cohort study comparing two RSV seasons (pre- and post-nirsevimab introduction).
  • Involved infants under 1 year hospitalized for acute lower respiratory tract infection across five Italian hospitals.
  • Bayesian hierarchical regression models analyzed RSV hospitalizations and disease severity, with a focus on gestational age as a modifying factor.

Main Results:

  • Nirsevimab significantly reduced RSV-related hospitalizations and the need for non-invasive respiratory support.
  • Infants receiving nirsevimab had a lower median gestational age at birth compared to the no-prophylaxis group.
  • Despite prophylaxis, lower gestational age was associated with an increased risk of hospitalization, indicating waning protection.

Conclusions:

  • Nirsevimab prophylaxis is effective in reducing RSV hospitalizations and severity in infants.
  • Protection conferred by nirsevimab appears to wane in preterm infants.
  • Modified dosing strategies for nirsevimab should be investigated for preterm infants to optimize protection.