title: Administration of Palivizumab in the NICU.
abstract: BACKGROUND
  The American Academy of Pediatrics recommends palivizumab prophylaxis against respiratory syncytial virus (RSV) for infants at high risk for severe disease within 72 hours of hospital discharge to prevent community-associated RSV. The American Academy of Pediatrics does not recommend palivizumab to prevent health care-associated RSV (HA-RSV).
  
  
  METHODS
  A retrospective, multicenter cohort of hospitalized infants who received nondischarge palivizumab (NDP) between January 2009 and December 2013 was established from 14 hospitals. NDP was defined as a charge for palivizumab >7 days before hospital discharge and no previous documented RSV. Infants were considered high risk for severe disease if they had chronic lung disease, chronic heart disease, or prematurity. Nondischarge palivizumab use was examined for high- and low-risk infants. HA-RSV was defined as an RSV-positive test (polymerase chain reaction, enzyme immunoassays, or culture) >3 days after admission and the frequency was measured for infants who did and did not receive NDP.
  
  
  RESULTS
  We identified 1263 patients who received at least 1 dose of NDP, most of whom were classified as high risk (80%). Among high-risk patients, the predictors of receipt of NDP included longer length of stay, institution, and no comorbid conditions. Most of the low-risk patients (88%) who received NDP had no comorbid conditions. NDP use varied widely among institutions. Overall, 25 eligible patients developed HA-RSV; 17 of whom received NDP.
  
  
  CONCLUSIONS
  Despite current recommendations, palivizumab for prevention of HA-RSV was common, even among patients at low risk of severe RSV.
authors.affiliation: Division of Infectious Diseases and Center for Pediatric Clinical Effectiveness, and Merck & Co., Blue Bell, Pennsylvania;
authors.forename: Neika
authors.initials: N
authors.lastname: Vendetti
authors.affiliation: Division of Infectious Diseases and Center for Pediatric Clinical Effectiveness, and Department of Pediatrics, and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Jeffrey S
authors.initials: JS
authors.lastname: Gerber
authors.affiliation: Division of Infectious Diseases and Center for Pediatric Clinical Effectiveness, and Department of Pediatrics, and Department of Infection Prevention and Control, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania;
authors.forename: Julia Shaklee
authors.initials: JS
authors.lastname: Sammons
authors.affiliation: Division of Infectious Diseases and Center for Pediatric Clinical Effectiveness, and Department of Pediatrics, and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Brian T
authors.initials: BT
authors.lastname: Fisher
authors.affiliation: Division of Infectious Diseases and Center for Pediatric Clinical Effectiveness, and Department of Pediatrics, and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: Theoklis E
authors.initials: TE
authors.lastname: Zaoutis
authors.affiliation: Division of Infectious Diseases and Center for Pediatric Clinical Effectiveness, and Department of Pediatrics, and Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania Department of Infection Prevention and Control, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; coffin@email.chop.edu.
authors.forename: Susan E
authors.initials: SE
authors.lastname: Coffin
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007297:Inpatients; D007363:Intensive Care Units, Neonatal; D015931:Intensive Care, Neonatal; D008297:Male; D000069455:Palivizumab / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D018357:Respiratory Syncytial Virus Infections / Q000517:prevention & control*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014481:United States
chemical_list: D000998:Antiviral Agents; D000069455:Palivizumab