New Research Counters American Academy of Pediatrics’ Restrictions on RSV Prophylaxis

by Amanda Conschafter, blog editor

For preemies facing respiratory syncytial virus (RSV), risk factors matter – and gestational age alone cannot determine whether infants need preventative treatment. So says a new study in the Italian Journal of Pediatrics, whose findings counter last year’s recommendations from the American Academy of Pediatrics.

[WATCH: Protect Premature Infants from RSV Virus]

The study, “Risk factors for bronchiolitis hospitalization during the first year of life in a multi center Italian birth cohort,” followed 2,314 newborns born preterm. Researchers categorized the infants into three groups based upon age:

  • Babies born between 33 and 34 weeks gestational age
  • Babies born between 35 and 37 weeks gestational age
  • Babies born at 37 weeks gestational age or later.

Data revealed that the infants born at 33-34 weeks had higher hospitalization rates due to RSV bronchiolitis.

However, the American Academy of Pediatrics’ 2014-2015 guidelines for RSV prophylaxis restrict preventative treatment against RSV almost solely to infants born before 29 weeks gestation. So even as infants born at 33-34 weeks demonstrate higher risk for RSV, in the United States they would likely be denied coverage for palivizumab – the only preventative treatment available.

[RELATED: New Guidelines Put Preemies at Risk]

The Italian study, authored by Silvia Vandini, also belies the AAP guidelines on another pivotal issue. The AAP guidelines deny the role of risk factors in determining which infants receive preventative RSV treatment. But the Vandini study identifies several risk factors affecting which infants are most susceptible. These include:

  • Male gender
  • Maternal smoking
  • Lack of breastfeeding
  • Siblings less than 10 years of age
  • Crowded living conditions
  • Early exposure to epidemic RSV season.

Thus, while AAP bases access to preventative treatment almost solely on gestational age, the Vandini study recommends individual assessment and access to preventative treatment at the discretion of health care providers.


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