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Impact of the 2014 American Academy of Pediatrics Policy on RSV Hospitalization in Preterm Infants in the United States.
Infect Dis Ther. 2021 Mar; 10(Suppl 1):17-26.ID

Abstract

Despite being a leading cause of hospitalization due to lower respiratory tract infections, the treatment of respiratory syncytial virus (RSV) infection is primarily supportive. Palivizumab is the only licensed immunoprophylaxis (IP) available for preventing severe RSV infection in high-risk populations including ≤ 35 weeks' gestational age (wGA) infants and children with chronic lung disease of prematurity or congenital heart disease. The American Academy of Pediatrics (AAP) has published its IP recommendations since the approval of palivizumab. In 2014, the AAP stopped recommending RSV IP in 29-34 wGA infants without comorbidities and stated that RSV hospitalization (RSVH) risk in otherwise healthy ≥ 29 wGA infants and term infants was similar. Since then, experts in the field have debated the appropriateness of the 2014 policy change, and several real-world evidence studies at the national and regional levels in the US have examined the impact of the AAP policy on 29-34 wGA infants. Overall, these studies showed a significant decline in RSV IP use and a concurrent increase in RSVH risk among 29-34 wGA infants relative to term infants in the seasons after the 2014 policy change. A similar decrease in IP use and increase in RSVH risk was also observed among < 29 wGA infants relative to term infants after the 2014 policy change. This decrease could be an unintended consequence as < 29 wGA infants are an in-policy population recommended to receive RSV IP. According to the National Perinatal Association, strong evidence exists to support the use of RSV IP in all ≤ 32 wGA and 32-35 wGA infants with risk factors such as attending day care, having ≥ 1 school-aged siblings, twin or greater multiple gestation, younger age, and exposure to parental smoking. Until new preventive and treatment options become available, palivizumab can help prevent and mitigate RSV disease burden among high-risk preterm infants.

Authors+Show Affiliations

Department of Pediatrics, Loma Linda University Children's Hospital, Loma Linda, CA, USA.Department of Infectious Diseases, Driscoll Children's Hospital, Corpus Christi, TX, USA.Department of Pediatrics, NYU Langone Hospital-Long Island and the NYU Long Island School of Medicine, Mineola, NY, USA. Leonard.Krilov@nyulangone.org.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

33656649

Citation

Goldstein, Mitchell, et al. "Impact of the 2014 American Academy of Pediatrics Policy On RSV Hospitalization in Preterm Infants in the United States." Infectious Diseases and Therapy, vol. 10, no. Suppl 1, 2021, pp. 17-26.
Goldstein M, Fergie J, Krilov LR. Impact of the 2014 American Academy of Pediatrics Policy on RSV Hospitalization in Preterm Infants in the United States. Infect Dis Ther. 2021;10(Suppl 1):17-26.
Goldstein, M., Fergie, J., & Krilov, L. R. (2021). Impact of the 2014 American Academy of Pediatrics Policy on RSV Hospitalization in Preterm Infants in the United States. Infectious Diseases and Therapy, 10(Suppl 1), 17-26. https://doi.org/10.1007/s40121-020-00388-1
Goldstein M, Fergie J, Krilov LR. Impact of the 2014 American Academy of Pediatrics Policy On RSV Hospitalization in Preterm Infants in the United States. Infect Dis Ther. 2021;10(Suppl 1):17-26. PubMed PMID: 33656649.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of the 2014 American Academy of Pediatrics Policy on RSV Hospitalization in Preterm Infants in the United States. AU - Goldstein,Mitchell, AU - Fergie,Jaime, AU - Krilov,Leonard R, Y1 - 2021/03/03/ PY - 2020/12/08/received PY - 2020/12/09/accepted PY - 2021/3/4/pubmed PY - 2021/3/4/medline PY - 2021/3/3/entrez KW - American Academy of Pediatrics KW - Bronchopulmonary dysplasia KW - Chronic lung disease of prematurity KW - Congenital heart disease KW - High-risk preterm infants KW - Immunoprophylaxis KW - National Perinatal Association KW - Palivizumab KW - RSV hospitalization KW - Respiratory syncytial virus SP - 17 EP - 26 JF - Infectious diseases and therapy JO - Infect Dis Ther VL - 10 IS - Suppl 1 N2 - Despite being a leading cause of hospitalization due to lower respiratory tract infections, the treatment of respiratory syncytial virus (RSV) infection is primarily supportive. Palivizumab is the only licensed immunoprophylaxis (IP) available for preventing severe RSV infection in high-risk populations including ≤ 35 weeks' gestational age (wGA) infants and children with chronic lung disease of prematurity or congenital heart disease. The American Academy of Pediatrics (AAP) has published its IP recommendations since the approval of palivizumab. In 2014, the AAP stopped recommending RSV IP in 29-34 wGA infants without comorbidities and stated that RSV hospitalization (RSVH) risk in otherwise healthy ≥ 29 wGA infants and term infants was similar. Since then, experts in the field have debated the appropriateness of the 2014 policy change, and several real-world evidence studies at the national and regional levels in the US have examined the impact of the AAP policy on 29-34 wGA infants. Overall, these studies showed a significant decline in RSV IP use and a concurrent increase in RSVH risk among 29-34 wGA infants relative to term infants in the seasons after the 2014 policy change. A similar decrease in IP use and increase in RSVH risk was also observed among < 29 wGA infants relative to term infants after the 2014 policy change. This decrease could be an unintended consequence as < 29 wGA infants are an in-policy population recommended to receive RSV IP. According to the National Perinatal Association, strong evidence exists to support the use of RSV IP in all ≤ 32 wGA and 32-35 wGA infants with risk factors such as attending day care, having ≥ 1 school-aged siblings, twin or greater multiple gestation, younger age, and exposure to parental smoking. Until new preventive and treatment options become available, palivizumab can help prevent and mitigate RSV disease burden among high-risk preterm infants. SN - 2193-8229 UR - https://www.unboundmedicine.com/medline/citation/33656649/Impact_of_the_2014_American_Academy_of_Pediatrics_Policy_on_RSV_Hospitalization_in_Preterm_Infants_in_the_United_States. L2 - https://dx.doi.org/10.1007/s40121-020-00388-1 DB - PRIME DP - Unbound Medicine ER -
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