Respiratory Syncytial Virus Disease in Preterm Infants in the US Born at 32–35 Weeks Gestation Not Receiving Immunoprophylaxis

Abstract

Supplemental Digital Content is available in the text.

Defining the Risk and Associated Morbidity and Mortality of Severe Respiratory Syncytial Virus Infection Among Preterm Infants Without Chronic Lung Disease or Congenital Heart Disease

“…RSVH rates for preterm infants over the last two decades vary in the literature [4, 5, 8–12, 29, 31, 37, 47, 49, 51–57], ranging from ~5/1000 children [4] to >100/1000 children [52, 53], with the highest RSVH rates reported in the lowest gestational age infants (Table 1). In the majority of these studies, RSV immunoprophylaxis was not given.…”

“…In the PICNIC study [9], the RSVH rate for infants born at 33–35 wGA was 36/1000 children, although center and seasonal variation in hospitalization rates for RSV infection were observed. A more recent study of 32–35 wGA infants followed prospectively from September to May 2009–2010 or 2010–2011 in the US [57], found that the observed hospitalization rate (49/1000 infant-seasons) was similar to that reported in other studies conducted outside the US that employed active surveillance for laboratory-confirmed RSV [9, 44]. In the PONI study [12], a multinational study (23 countries) of 33–35 wGA infants ≤6 months of age during the October 2013 to April 2014 RSV season, the RSVH rate was 61/1000 infant-years.…”

“… BPD bronchopulmonary dysplasia, hs hemodynamically significant, CHD congenital heart disease, CLD chronic lung disease, NICU neonatal intensive care unit, RSV (+) respiratory syncytial virus (positive), wGA weeks’ gestational age a Per 1000 infant-years b Per 1000 years of risk c Per 1000 infants d Infants 29–32 wGA or 29–35 wGA e Gestational age could not be verified for 24 RSV-positive children f Infants <37 wGA g Infants 33 to <36 wGA h Infants <30 wGA i Infants <37–41 wGA j Incidence rate for first RSVH for children in first 18 months of life (<36 wGA without BPD or CLD) k Infants 36 wGA l Infants 23–32 wGA m Infants ≤36 wGA and <6 months of age n Infants 42–45 wGA o Combined analysis of Liese [57] and Resch [56] p Included 2 cohorts, one of infants born 2008–2009, other of infants born 2009–2011 q Infants ≤32 wGA, incidence rate adjusted to compensate for RSV prophylaxis r Infants without CLD, CHD or prematurity, incidence rate adjusted to compensate for RSV prophylaxis s Follow-up of Blanken [10] t Western Europe (Austria, France, Norway, Portugal, Sweden, and Switzerland), Eastern Europe (Bosnia, Bulgaria, Czech Republic, Estonia, Latvia, Lithuania, Slovakia, and Slovenia) and Russia, South Korea, Mexico, and the Middle East (Bahrain, Egypt, Jordan, Lebanon, Oman, and Saudi Arabia)…”

“…Results from a number of studies show that preterm infants are at an increased risk for morbidity and increased rates of health care resource utilization, including longer duration of illness and longer hospital stays, compared with full-term infants [5, 8, 14, 16, 29, 46, 50, 57, 64–72]. Data also show that nosocomial RSV infection in high-risk infants, including preterm infants, often follows a severe course of disease [73].…”

Re-evaluating the New Committee on Infectious Diseases Recommendations for Palivizumab Use in Premature Infants

“…In addition, a recent study that reviewed the current risk of RSV-related hospitalization in preterm infants at 188 US outpatients' clinics documented that RSV hospitalizations were highest in infants 32-35 weeks gestational age who were 6 months of age or less during November through March with day care attendance or nonmultiple-birth, preschool-aged siblings (8.9 and 9.3 per 100 infant-seasons, respectively). 18 Given these concerns, we suggest that a more transparent re-evaluation of the new COID/Bronchiolitis Subcommittee recommendations should be considered that include:…”