title: Have Changing Palivizumab Administration Policies Led to More Respiratory Morbidity in Infants Born at 32-35 Weeks?
abstract: OBJECTIVE
  To determine differences in the incidence of respiratory morbidity during the first year of life among infants born 32(0/7)-34(6/7) weeks' gestational age (GA) before and after the administration policy for palivizumab, as written by the American Academy of Pediatrics, was updated in 2009.
  
  
  METHODS
  Secondary analysis of the dataset collected for the Gastrointestinal Risk Factors for Wheezing in Premature Infants study, which enrolled preterm infants without bronchopulmonary dysplasia and followed them by parental questionnaires at 3, 6, 9, and 12 months adjusted age for prematurity. Participants were included if they were enrolled in Gastrointestinal Risk Factors for Wheezing in Premature Infants, born 32(0/7)-34(6/7) weeks' GA, and completed the 12-month questionnaire. We compared rates of recurrent wheezing, respiratory medication use, and health care use before (Epoch 1) and after (Epoch 2) the 2009 administration policy change.
  
  
  RESULTS
  A total of 165 infants met inclusion criteria. There was a significant increase in recurrent wheezing in Epoch 2 (46.2%) vs Epoch 1 (28.8%) (OR 2.22 [95% CI 1.08-4.53], P = .03). There was a nonsignificant increase in visits to the emergency department in Epoch 2 (27.4%) vs Epoch 1 (15.3%) (OR 2.12 [95% CI 0.91-4.96], P = .08). There were no differences in hospital admissions or respiratory medication use.
  
  
  CONCLUSIONS
  Infants born 32(0/7)-34(6/7) weeks' GA treated after the American Academy of Pediatrics administration policy change in 2009 had a greater incidence of recurrent wheezing than those treated according to the previous policy. It will be important to track rates of recurrent wheezing after the 2014 administration policy, because it may be an important factor in future cost-effectiveness analyses.
authors.affiliation: University Hospitals Case Medical Center, Rainbow Babies and Children's Hospital, Cleveland, OH. Electronic address: arielle.olicker@uhhospitals.org.
authors.forename: Arielle
authors.initials: A
authors.lastname: Olicker
authors.affiliation: Case Western Reserve University, Cleveland, OH.
authors.forename: Hong
authors.initials: H
authors.lastname: Li
authors.affiliation: University Hospitals Case Medical Center, Rainbow Babies and Children's Hospital, Cleveland, OH; Case Western Reserve University, Cleveland, OH.
authors.forename: Curtis
authors.initials: C
authors.lastname: Tatsuoka
authors.affiliation: University Hospitals Case Medical Center, Rainbow Babies and Children's Hospital, Cleveland, OH; Case Western Reserve University, Cleveland, OH.
authors.forename: Kristie
authors.initials: K
authors.lastname: Ross
authors.affiliation: University Hospitals Case Medical Center, Rainbow Babies and Children's Hospital, Cleveland, OH; Case Western Reserve University, Cleveland, OH.
authors.forename: Andrea
authors.initials: A
authors.lastname: Trembath
authors.affiliation: University Hospitals Case Medical Center, Rainbow Babies and Children's Hospital, Cleveland, OH; Case Western Reserve University, Cleveland, OH.
authors.forename: Anna Maria
authors.initials: AM
authors.lastname: Hibbs
mesh_terms: D000047:Academies and Institutes; D001997:Bronchopulmonary Dysplasia / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D005865:Gestational Age; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000188:drug therapy / Q000453:epidemiology; D008297:Male; D000069455:Palivizumab / Q000008:administration & dosage* / Q000191:economics; D010343:Patient Admission; D010372:Pediatrics / Q000592:standards*; D012135:Respiratory Sounds; D018357:Respiratory Syncytial Virus Infections / Q000188:drug therapy* / Q000453:epidemiology; D012141:Respiratory Tract Infections / Q000188:drug therapy* / Q000191:economics / Q000453:epidemiology; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D000069455:Palivizumab