title: Impact of the Updated Guidance for Palivizumab Prophylaxis against Respiratory Syncytial Virus Infection: A Single Center Experience.
abstract: To determine the differences in number of respiratory syncytial virus (RSV) hospitalizations and outcomes in infants 290/7-346/7weeks' gestational age (wGA) the season before (season 1 [S1]; 2013-2014) and after (season 2 [S2]; 2014-2015) implementation of the 2014 American Academy of Pediatrics revised guidance for palivizumab prophylaxis.
  
  
  
  Children <12 months of age hospitalized with RSV infection were identified by the International Classification of Diseases, Ninth Revision codes and virology reports. Clinical, outcome data, palivizumab eligibility, and hospital charges were compared among infants 29-34 wGA in S1 vs S2.
  
  
  
  Of 1063 RSV hospitalizations in infants <12 months old, 7.1% (34/482) in S1 and 9.8% (57/581) in S2 occurred in 290/7-346/7wGA infants. On the other hand, 29-34 wGA infants who were <6 months old constituted 3.5% (17/482) of RSV hospitalizations in S1 vs 7.1% (41/581) in S2 (P = .01). Among 290/7-346/7wGA healthy infants who were <3 months old, oxygen administration (40.0% vs 78.9%; P = .05), pediatric intensive care unit admission (30.0% vs 68.4%; P = .04), mechanical ventilation (10.0% vs 52.6%; P = .04), duration of hospitalization (1.8 vs 8.8 days; P = .04), and hospital charges ($19 686 vs $30 662; P = .03) significantly increased in S2 vs S1. No differences in morbidity were observed in premature infants who were 3 to <6 and 6 to <12 months between seasons. Palivizumab eligibility decreased from 32.3% in S1 to 1.8% in S2 (P < .001). One infant died in each season.
  
  
  
  In the year following implementation of the 2014 palivizumab prophylaxis guidance, there was an increase in RSV hospitalizations and associated morbidity among 29-34 wGA infants of younger chronological age.
authors.affiliation: Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
authors.forename: Bavani
authors.initials: B
authors.lastname: Rajah
authors.affiliation: Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Division of Neonatology, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH; Division of Pediatric Infectious Diseases, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH.
authors.forename: Pablo J
authors.initials: PJ
authors.lastname: Sánchez
authors.affiliation: Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
authors.forename: Cristina
authors.initials: C
authors.lastname: Garcia-Maurino
authors.affiliation: Department of Pathology and Laboratory Medicine, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH.
authors.forename: Amy
authors.initials: A
authors.lastname: Leber
authors.affiliation: Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Division of Pediatric Infectious Diseases, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH.
authors.forename: Octavio
authors.initials: O
authors.lastname: Ramilo
authors.affiliation: Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Division of Pediatric Infectious Diseases, Nationwide Children's Hospital and The Ohio State University College of Medicine, Columbus, OH. Electronic address: Asuncion.Mejias@nationwidechildrens.org.
authors.forename: Asuncion
authors.initials: A
authors.lastname: Mejias
mesh_terms: D000998:Antiviral Agents / Q000627:therapeutic use*; D005260:Female; D017722:Hospital Charges / Q000706:statistics & numerical data; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D008297:Male; D000069455:Palivizumab / Q000627:therapeutic use*; D018357:Respiratory Syncytial Virus Infections / Q000191:economics / Q000453:epidemiology* / Q000517:prevention & control; D018113:Respiratory Syncytial Virus, Human / Q000187:drug effects*
chemical_list: D000998:Antiviral Agents; D000069455:Palivizumab
keywords: disease severity; hospitalizations; palivizumab; premature infants