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Original Research: Pediatrics |

Short- and Long-term Pulmonary Outcome of Palivizumab in Children Born Extremely Prematurely

Dario Prais, MD; Eytan Kaplan, MD; Gil Klinger, MD; Huda Mussaffi, MD; Meir Mei-Zahav, MD; Ephraim Bar-Yishay, PhD; Patrick Stafler, MD; Guy Steuer, MD; Lea Sirota, MD; Hannah Blau, MBBS
Author and Funding Information

FUNDING/SUPPORT: This work was supported by an investigator-initiated grant from Abbott.

CORRESPONDENCE TO: Dario Prais, MD, Pulmonary Institute, Schneider Children’s Medical Center of Israel, Petach Tikva 49202, Israel


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2016;149(3):801-808. doi:10.1378/chest.15-0328
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Background  Palivizumab reduces the severity of respiratory syncytial virus infection in premature infants, but whether there is a protective effect beyond the preschool age is unknown. This study sought to assess the short- and long-term effects of palivizumab immunization on respiratory morbidity and pulmonary function at school age in children born extremely prematurely.

Methods  Infants born before 29 weeks’ gestation in 2000 to 2003 were assessed at school age by parental questionnaire, hospital chart review, and lung function tests. Children born immediately before the introduction of routine palivizumab prophylaxis were compared with age-matched children who received palivizumab prophylaxis during the first respiratory syncytial virus season.

Results  Sixty-three children with a mean age 8.9 years were included: 30 had received palivizumab and 33 had not (control subjects). The groups were similar in terms of gestational age, birth weight, need for mechanical ventilation, and oxygen supplementation. Fifty-three percent of the palivizumab group, compared with 39% of the control group, had bronchopulmonary dysplasia (P = .14). Wheezing occurred in the first 2 years of life in 27% of the palivizumab group and in 70% of control subjects (P = .008); respective hospitalization rates were 33% and 70% (P = .001). At school age, rates of hyperresponsiveness (provocative concentration leading to a 20% fall in FEV1 < 1 mg/mL) were 33% and 48%, respectively (P = .38). Spirometry, lung volumes, diffusion, and exhaled nitric oxide were within normal limits, with no significant differences between groups.

Conclusion  Palivizumab prophylaxis was associated with reduced wheezing episodes and hospitalizations during the first 2 years of life in children born extremely prematurely. However, it did not affect pulmonary outcome at school age.

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