The information below is being provided as a seasonal update on RSV prophylaxis by William J. Cashore, M.D., Associate Chief of Pediatrics at W&I and Professor of Pediatrics at the Warren Alpert Medical School of Brown University.
As before, we consider the RSV "season" to last from November through March. Annual changes in weather patterns and viral strains may affect the actual onset and duration of the "season". For your convenience, I will summarize current AAP recommendations for RSV prophylaxis:
- Infants less than one year old with hemodynamically significant congenital heart disease. (Some infants over a year old with chronic congestive heart failure may benefit from a second season of prophylaxis.)
- Infants of 29-32 weeks gestation and less than six months old.
- Infants of 28 weeks gestation or less, who are less than one year old as of November, 2008.
- Infants with severe chronic lung disease of prematurity (any gestational age), less than one year old, and requiring therapy for their BPD within the past six months.
- Extremely low birth weight infants over one year of age, but requiring active treatment for bronchopulmonary dysplasia during the past six months, may benefit from a second season of prophylaxis.
- The AAP recommends a 5-dose course beginning in November and ending in March. Our Division of Pediatric Infectious Diseases concurs with this recommendation.
Children with allergic airway disease, but not chronic lung disease of prematurity, are not likely to benefit from monoclonal antibody RSV prophylaxis. The benefits of prophylaxis for infants with cystic fibrosis have also not been established.
Additional information about eligibility and seasonal scheduling for RSV prophylaxis can be found on the AAP's web site.
Beginning in November, we shall initiate RSV prophylaxis in the Special Care Nursery as a first dose prior to discharge for infants of 32 weeks gestation or less, expected to go home between November and March. For these infants, we shall try to notify you at time of discharge of their treatment eligibility and the date of their first dose. We shall not routinely give an inpatient dose to otherwise low-risk infants of 33 to 35 weeks.
At present, we do not have resources at Women & Infants' Hospital of RI for out-patient prophylaxis in our discharged patients. We have had an excellent response from several home-care and pharmacy services in the community.
For current information about the eligibility or initial prophylaxis of Special Care Nursery patients, please feel free to contact our Special Care Nursery case managers at 401-274-1122, Ext. 1835.
I hope you will find this information helpful. I remain available for questions about the medical status of individual patients. However, our office staff here is not able to make direct arrangements for appointments or out-patient follow up.
Thank you for your help with this important undertaking.