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RSV Prophylaxis in Preterm Infants

Betty Danford

COMM/215

January 12, 2015
Yvonna Starr Carnieri

RSV Prophylaxis in Preterm Infants

Respiratory syncytial virus or RSV is a common infection in young children usually causing only mild cold and upper respiratory symptoms. Infants with chronic lung disease and premature infants are likely to have more serious effects, including re-hospitalization and respiratory assistance (Haelle, 2014). In July of 2014, the American Academy of Pediatrics issued updated guidelines to decrease RSV prophylaxis for preterm infants. I work in a neonatal intensive care unit and support the new guidelines that reduce the number of infants that qualify for RSV prophylaxis. RSV prophylaxis or Synagis is administered to qualifying infants prior to discharge from the neonatal intensive care unit and given monthly throughout RSV season. Previous guidelines included dosing any preterm infant 31.6 weeks gestation and below throughout the RSV fall and winter season. Infants born between 32 and 35 weeks gestation qualified for RSV prophylaxis based on risk factors of: living in a home with children or siblings five years of age or less and day care attendance. The updated guidelines in 2014 recommend RSV prophylaxis for all infants born before 29 and 0 days gestation. Infants born before 32 weeks qualify for RSV prophylaxis if they require > 21% oxygen for 28 consecutive days following birth. RSV prophylaxis remains relatively the same for infants with congenital heart disease and pulmonary and neuromuscular abnormalities (AAP Policy Statement, 2014). The cost of Synagis dosing can run as high as $15,000 for one infant per season. Insurance companies reimburse dosing only for infants that qualify per AAP guidelines. Dosing outside of the guidelines can leave a financial burden on the family. Synagis is an immunoglobulin antibody; it is not a vaccine. It does not prevent infection but can lessen the symptoms of RSV infection in some infants. Synagis does not treat RSV infection. The updated guidance is “driven by the limited clinical benefit derived from Synagis prophylaxis” and “Synagis prophylaxis has limited effect on RSV hospitalizations on a population basis, no measurable effect on mortality, and a minimal effect on subsequent wheezing” (AAP Policy Statement, 2014). The risk of RSV infection can be significantly reduced by practicing proper hand washing, keeping a clean environment, and regularly washing toys and linens. Breast milk is the best nutritional choice for all infants. According to “Breastfeeding Benefits Your Baby’s Immune System” (2014) “Human milk provides virtually all the protein, sugar, and fat your baby needs to be healthy, and it also contains many substances that benefit your baby’s immune system, including antibodies, immune factors, enzymes, and white blood cells. These substances not only protect your baby against a wide variety of diseases and infections not only while breastfeeding, but long after he is weaned” (para.1). Parents should understand it is important to avoid crowds, eliminate smoking, and exposure to environmental pollutants. Immunizing all family members against influenza and practice good cough hygiene is essential. I support the current AAP guidelines; Preterm infants born before 29 weeks gestation and preterm infants with chronic lung disease requiring mechanical ventilation and oxygen supplementation for > 28 days should receive RSV prophylaxis. All preterm infants with chronic lung disease going home with supplemental oxygen should receive RSV prophylaxis. Healthy preterm infants without lung disease born after 29 weeks gestation do not meet criteria and should not receive RSV prophylaxis. A critical component of RSV prevention for all infants is family education in decreasing exposure and the transmission of RSV. It is our job as medical professionals to identify unhealthy lifestyles, educate families, and involve services to support them as they make changes towards healthy living. .
References
America Academy of Pediatrics Committee on Infectious Diseases and Bronchiolitis Guidelines Committee. Updated guidance for palvizumab prophylaxis among infants and young children at increased risk of hospitalization for respiratory syncytial virus infection. Pediatrics 2014.
Breast feeding benefits your baby’s immune system. (2014). Retrieved from http://aaphealthychildren.org
Haelle, T, (2014, August. New guidelines further restrict synagis in RSV prophylaxis. Pediatric News, 48(37-39).

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