Observed Effectiveness of Palivizumab for 29–36-Week Gestation Infants

Farber, Harold J.; Buckwold, Frederick J; Lachman, Barry S.; Simpson, Jill; Buck, Ernest; Arun, Matha; Valadez, Adolfo M.; Ruiz, Teresa; Alonzo, Joy; Henry, Andrea; Cos-Okpalla, Nneka; Nguyen, Kelsey; Brendel, William; Small, James C.; Glomb, William B.

doi:10.1542/peds.2016-0627

Cited by 33 publications

(31 citation statements)

References 13 publications

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“…However, the use of palivizumab is currently restricted to high-risk infants, as the American Academy of Pediatrics only recommends immunoprophylaxis with palivizumab during the first year of life for infants born at <29 week’s gestation with coexisting morbidities including BPD or hemodynamically unstable cardiovascular disease [85]. Such restricted use of palivizumab has been largely related to the high cost of this treatment (estimated cost for a single course approximately $US 4458 per child), as well as the uncertainty about cost-effectiveness, with recent studies reporting limited or no effect of palivizumab among otherwise healthy preterm infants born at or after 29 weeks’ gestation [86–88]. To date, there is no effective acute treatment for RSV, even in high risk groups such as preterm infants.…”

Section: Viral Infection Requiring Readmission In Early Lifementioning

confidence: 99%

The impact of respiratory viruses on lung health after preterm birth

Townsi

Laing

Hall

et al. 2018

European Clinical Respiratory Journal

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Children born preterm, less than 37 weeks’ gestation, are at increased risk of viral respiratory infections and associated complications both during their initial birth hospitalisation and in their first years following discharge. This increased burden of viral respiratory infections is likely to have long term implications for lung health and function in individuals born preterm, particularly those with bronchopulmonary dysplasia. Several hypotheses have been put forward to explain the association between early life viral respiratory infection and development of suboptimal lung health and function later in life following preterm birth. Although preterm infants with diminished lung function, particularly small airways, might be particularly susceptible to asthma and wheezing disorders following viral infection, there is evidence that respiratory viruses can activate number of inflammatory and airway re-modelling pathways. Therefore, the aim of this review is to highlight the perinatal and early life risk factors that may contribute to increased susceptibility to viral respiratory infections among preterm infants during early life and to understand how respiratory viral infection may influence the development of abnormal lung health and function later in life.

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Section: Viral Infection Requiring Readmission In Early Lifementioning

confidence: 99%

The impact of respiratory viruses on lung health after preterm birth

Townsi

Laing

Hall

et al. 2018

European Clinical Respiratory Journal

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“…The guidance remains controversial with literature in support of and against the new restrictions [4][5][6][7][8]. Farber, et al studied infants born over a three-year period between 29-36 weeks gestation without chronic illness in Texas who were enrolled in managed Medicaid.…”

Section: Original Articlementioning

confidence: 99%

“…Among those born between 29-32 weeks gestation, palivizumab prophylaxis receipt was associated with reduced hospitalization for RSV disease, but increased hospitalization for non-RSV bronchiolitis. They concluded that the more restrictive guidance of 2014 overall had little impact on this population [4]. Likewise, a study of hospital utilization of palivizumab found the restrictive guidance did not have an effect on nosocomial RSV and resulted in significant cost savings [6].…”

Section: Original Articlementioning

confidence: 99%

Impact of Adopting 2014 Guidance for Palivizumab Prophylaxis for Children Previously Considered at High Risk for Severe Respiratory Syncytial Virus Disease

Quick¹

2017

Int J Respir Pulm Med

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Objectives: This is a report of pediatric patients hospitalized with Respiratory Syncytial Virus Infection (RSV) during the season prior to, and 2 seasons following the 2014 palivizumab prophylaxis guidance release. The primary aim was to determine the effect of the 2014 guidance on children no longer considered eligible for prophylaxis. Secondary aims were to 1) Describe and compare morbidity among all children hospitalized with RSV following the 2014 guidance, 2) Assess adherence to the updated guidance, and 3) Assess associated drug cost savings. Study design:We performed a retrospective chart review of pediatric patients admitted for RSV disease at our institution during the RSV season from October 2013 -March 2016. Patients who met prior palivizumab qualifications, but were excluded according to 2014 guidance were compared pre and post adoption of 2014 palivizumab guidance. Neonatal Intensive Care Unit (NICU) records were assessed for adherence to 2014 guidance and resulting palivizumab drug cost was compared.Results: Among cases qualifying according to previous guidance, but excluded in the 2014 update, there were no significant differences seen in the rate of RSV hospitalization, admission to higher level of care, increased respiratory support requirement, or length of stay. Following the adoption of 2014 guidance, palivizumab dosing was reduced by 58%; the rate of appropriate prophylaxis among NICUs was 91%. This reduction resulted in an annual drug cost savings of $225,000. Conclusion:Adoption of updated 2014 guidance at our institutions had little impact on hospitalization with RSV disease, while allowing for better resource management.

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“…The investigators evaluated the effect of palivizumab administration on hospitalization for bronchiolitis with or without an RSV diagnosis among healthy preterm infants born at 29 to 36 weeks of gestation during their first RSV season occurring in 2012, 2013, or 2014. 4 These infants did not have conditions known to increase hospitalization rates for RSV, specifically, chronic lung disease of prematurity or congenital heart disease. Although the recommendations to limit use of palivizumab in healthy preterm infants were released in July 2014, the Texas Medicaid program did not fully adopt them until 2015.…”

mentioning

confidence: 98%

“…In this issue of Pediatrics, Farber et al 4 provide data from nine Medicaid managed care health programs in Texas supporting the 2014 recommendation. The investigators evaluated the effect of palivizumab administration on hospitalization for bronchiolitis with or without an RSV diagnosis among healthy preterm infants born at 29 to 36 weeks of gestation during their first RSV season occurring in 2012, 2013, or 2014.…”

mentioning

confidence: 99%

Palivizumab Prophylaxis for Healthy Preterm Infants: More Data Supporting American Academy of Pediatrics Guidelines

Byington

2016

Pediatrics

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Observed Effectiveness of Palivizumab for 29–36-Week Gestation Infants

Cited by 33 publications

References 13 publications

The impact of respiratory viruses on lung health after preterm birth

The impact of respiratory viruses on lung health after preterm birth

Impact of Adopting 2014 Guidance for Palivizumab Prophylaxis for Children Previously Considered at High Risk for Severe Respiratory Syncytial Virus Disease

Palivizumab Prophylaxis for Healthy Preterm Infants: More Data Supporting American Academy of Pediatrics Guidelines

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