The RSV "season" lasts from November through March. Annual changes in weather patterns and viral strains may affect the actual onset and duration of the "season". This year'sAmerican Academy of Pediatrics(AAP) recommendations for prophylaxis are unchanged from last year and are summarized below.
Infants < 290 weeks gestation or less, and less than one year old as of November, 2015.
Infants of < 320 weeks gestation with chronic lung disease (> 21% inspired oxygen for at least 28 days after birth) and less than one year old in November 2015.
Infants of < 320 weeks gestation with chronic lung disease (> 21% oxygen for at least 28 days after birth) and between one and two years old as of November who require ongoing medical treatment for chronic lung disease (supplemental oxygen, diuretic or steroid therapy).
Infants < one year old with hemodynamically significant congenital heart disease (consultation with a cardiologist is recommended).
Infants with pulmonary abnormalities or neuromuscular disease that compromises respiratory secretions.
Infants < two years of age with profound immunocompromise.
The AAP and our infectious disease service recommend prophylaxis beginning in November and ending in March with a maximum of five doses. April doses are not recommended.
Monthly prophylaxis should be discontinued in anyone who develops breakthrough RSV hospitalization. Prophylaxis is not recommended for prevention of RSV nosocomial disease. The benefits of prophylaxis for infants with cystic fibrosis or Down syndrome have not been established.
Additional information about eligibility and seasonal scheduling for RSV prophylaxis can be found on theAAP's website.
Beginning in November, we shall initiate RSV prophylaxis in the NICU as a first dose prior to discharge for appropriate infants expected to go home between November and March. For preterm infants, we will inform medical providers at discharge of their treatment eligibility and date of their first dose. Whenever possible, we will give the first dose of 15 mg/kg 2 to 4 days before anticipated discharge.
We do not have resources at Women & Infants for outpatient 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 NICU patients, please feel free to contact our NICU care managers at (401) 274-1122, ext. 43371.