Recommended
Palivizumab in the first year of life for:
1) Infants born before 29 weeks, 0 days’ gestation,
2) Preterm infants with chronic lung disease (CLD) of prematurity, defined as birth at <32 weeks, 0 days’ gestation and a requirement for >21% oxygen for at least 28 days after birth.
3) Infants with hemodynamically significant heart disease,
Consider for infants < 1-year-old who have pulmonary abnormalities or neuromuscular disease that impairs the ability to clear upper airway secretions, or for children < 2 years old who will be profoundly immunocompromised during the RSV season.
Palivizumab in the 2nd year of life for:
1) Children with chronic lung disease who require continued medical intervention (e.g., supplemental oxygen, chronic corticosteroid therapy, diuretics).
Not Recommended
Palivizumab prophylaxis is not recommended
-for otherwise healthy infants born at or after 29 weeks, 0 days’ gestation.
-in the second year of life except for children who required at least 28 days of supplemental oxygen after birth and who continue to require medical intervention (supplemental oxygen, chronic corticosteroid, or diuretic therapy).
-for prevention of healthcare-associated RSV disease.
Insufficient data are available to recommend palivizumab prophylaxis for children with cystic fibrosis or Down syndrome.
Additional Guidance
-Clinicians may administer up to a maximum of 5 monthly doses of palivizumab (15 mg/kg per dose) during the RSV season to infants who qualify for prophylaxis in the first year of life. Qualifying infants born during the RSV season may require fewer doses. For example, infants born in January would receive their last dose in March.
-Monthly prophylaxis should be discontinued in any child who experiences a breakthrough RSV hospitalization.
-The burden of RSV disease and costs associated with transport from remote locations may result in a broader use of palivizumab for RSV prevention in Alaska Native populations and possibly in selected other American Indian populations.
Reference / Further Reading
Pediatrics. 2014;134(2):e620–e638. Updated Guidance for Palivizumab Prophylaxis Among Infants and Young Children at Increased Risk of Hospitalization for Respiratory Syncytial Virus Infection. http://pediatrics.aappublications.org/content/134/2/415