title: Evaluation of compliance with palivizumab recommendations in a multicenter study of young children presenting to the emergency department with bronchiolitis.
abstract: OBJECTIVE
  Monthly palivizumab injections from November to March decrease risk of respiratory syncytial virus (RSV)-related hospitalization during RSV season in high-risk infants born less than 35 weeks of gestation. Our objective was to investigate compliance with the American Academy of Pediatrics (AAP) recommendations for palivizumab prophylaxis among children who present to the emergency department (ED) with bronchiolitis.
  
  
  METHODS
  Seventeen centers, from 9 US states, performed a prospective, observational study of ED patients less than 2 years with an attending physician diagnosis of bronchiolitis. Researchers conducted a structured interview, followed by a chart review, and a 2-week follow-up phone call.
  
  
  RESULTS
  Of 825 eligible children, 624 (73%) were enrolled. According to AAP recommendations, 35 children (6%) should have received palivizumab, but only 17 (49%; 95% confidence interval, 31%-66%) did. Prophylaxis with palivizumab did not differ by US region (P > 0.50). The ED clinical presentations were similar when comparing those children that did and did not receive prophylaxis (all P > 0.27). Those receiving palivizumab were more likely to come to the ED using systemic corticosteroids (22% vs 7%; P = 0.003) and to be treated with corticosteroids in the ED (31% vs 15%; P = 0.02). The 2 groups were at similar risk of hospitalization (52% vs 39%; P = 0.11).
  
  
  CONCLUSIONS
  According to parental report, only half of children presenting to the ED with bronchiolitis who met AAP criteria for palivizumab prophylaxis received this monoclonal antibody. Emergency department visits provide an untapped opportunity for staff to educate families and communicate with PCPs about RSV prophylaxis.
authors.affiliation: Department of Medicine, Children's Hospital Boston, MA 02115, USA. jonathan.mansbach@childrens.harvard.edu
authors.forename: Jonathan
authors.initials: J
authors.lastname: Mansbach
authors.forename: Sarah
authors.initials: S
authors.lastname: Kunz
authors.forename: Uchechi
authors.initials: U
authors.lastname: Acholonu
authors.forename: Sunday
authors.initials: S
authors.lastname: Clark
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
mesh_terms: D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents / Q000008:administration & dosage*; D001990:Bronchiolitis, Viral / Q000517:prevention & control*; D004635:Emergency Medicine / Q000592:standards / Q000706:statistics & numerical data; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D008297:Male; D000069455:Palivizumab; D010372:Pediatrics / Q000592:standards / Q000706:statistics & numerical data; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D014481:United States
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000998:Antiviral Agents; D000069455:Palivizumab