title: Can we improve the targeting of respiratory syncytial virus (RSV) prophylaxis in infants born 32-35 weeks' gestational age with more informed use of risk factors?
abstract: OBJECTIVE
  To evaluate the key risk factors for respiratory syncytial virus (RSV) hospitalisation in 32-35 weeks' gestational age (wGA) infants.
  
  
  METHODS
  Published risk factors were assessed for predictive accuracy (area under the receiver operating characteristic curve [ROC AUC]) and for number needed to treat (NNT).
  
  
  RESULTS
  Key risk factors included: proximity of birth to the RSV season; having siblings; crowding at home; day care; smoking; breast feeding; small for GA; male gender; and familial wheezing/eczema. Proximity of birth to the RSV season appeared the most predictive. Risk factors models from Europe and Canada were found to have a high level of predictive accuracy (ROC AUC both > 0.75; NNT for European model 9.5). A model optimised for three risk factors (birth ± 10 weeks from start of RSV season, number of siblings ≥ 2 years and breast feeding for ≤ 2 months) had a similar level of prediction (ROC AUC: 0.776; NNT: 10.2). An example two-risk factor model (day care attendance and living with ≥ 2 siblings < 5 years old) had a lower level of predictive accuracy (ROC AUC: 0.55; NNT: 26).
  
  
  CONCLUSIONS
  An optimised combination of risk factors has the potential to improve the identification of 32-35 wGA infants at heightened risk of RSV hospitalisation.
authors.affiliation: a Neonatology Service, Hospital Clinic , Institut d'Investigacios Biomediques August Pi Suñer (IDIBAPS) , Barcelona , Spain .
authors.forename: Xavier
authors.initials: X
authors.lastname: Carbonell-Estrany
authors.forename: John R
authors.initials: JR
authors.lastname: Fullarton
authors.forename: Barry S
authors.initials: BS
authors.lastname: Rodgers-Gray
authors.forename: Katherine L
authors.initials: KL
authors.lastname: Gooch
authors.forename: Pamela G
authors.initials: PG
authors.lastname: Vo
authors.forename: Jose
authors.initials: J
authors.lastname: Figueras-Aloy
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D019540:Area Under Curve; D005260:Female; D005865:Gestational Age; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D061366:Numbers Needed To Treat; D018357:Respiratory Syncytial Virus Infections / Q000209:etiology / Q000517:prevention & control*; D012136:Respiratory Syncytial Viruses; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D000998:Antiviral Agents
keywords: Bronchiolitis; NNT; hospitalisation; palivizumab; premature infants