AAP Redbook guidelines for RSV prophylaxis include children < 2 yrs of age with chronic lung disease (CLD) and those with congenital heart disease (CHD). Since 2000, the Outcomes Registry has evaluated clinical practice among ∼20,000 children receiving RSV prophylaxis. This analysis was performed to characterize how RSV prevention is being clinically applied to at risk term children.
6087 children from 175 sites across the US who received at least one dose of palivizumab after June 1, 2003 were enrolled in the 2003-2004 Registry. Demographics, risk factors for RSV, injection history, and confirmed RSV-hospitalizations were recorded. Data for term children are presented.
Fifteen percent (n=918) of the enrollees were >35 wks GA, up from 8% in 2000. Seventy percent of term children were Caucasian compared with 54% of those < 35 wks GA (p<0.001). Almost 60% of term infants reported either CHD (41%) or CLD (18%), compared to 21% with CHD in 2002-03. Risk factors for RSV included CF (3%), daycare (55%) or tobacco smoke exposure (19%), 3 2 people sharing a bedroom (47%), multiple birth (9%). Additionally, 45% had Medicaid compared to 49% of premature infants (p=0.0231). Term children were surveyed for the primary diagnostic reason for RSV prophylaxis: CHD (37%), CLD other than due to prematurity (16%), CF (3%), airway abnormality (4%), pulmonary hypoplasia/diaphragmatic hernia (2%), and other (38%).
Clinical practice reporting in the Registry shows increasing use of palivizumab in term children, many who have important risk factors for RSV. Increasing use in children with CHD is likely related to changes in guidelines and recent study results.
Physicians are increasingly identifying term children in whom RSV prevention appears appropriate, predominantly those with CHD and CLD.
B. McWilliams, MedImmune, Inc