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Iowa Neonatology Handbook: Infection
Guidelines for Immunoprophylaxis Against Respiratory Syncytial
Virus in High-Risk Infants
Edward F. Bell, MD and Jonathan M. Klein, MD
Peer Review Status: Internally Peer
Reviewed
Division of Neonatology, University of Iowa Children's Hospital
The following guidelines are suggested for selecting patients to
receive RSV immune globulin (RespiGamTM) or humanized RSV
monoclonal antibody (SynagisTM) to reduce the risk of
serious RSV infection during RSV season.
RespiGamTM
Infants with severe chronic lung disease, defined as
follows, should be considered for monthly infusions of
RespiGamTM.
- Infants less than 6 months of age requiring home oxygen
therapy at _ lpm or more, and
- Infants 6 months to 1 year of age requiring home oxygen
at _ lpm or more.
These infusions should begin at the onset of RSV season or, if the
infant is discharged from the hospital during RSV season, at the time
of discharge; the infusions should be continued once monthly until
the end of RSV season.
SynagisTM
Other infants (below 2 years of age) who require home
oxygen therapy (or who have just come off oxygen therapy in the 2
months prior to the onset of RSV season) but do not meet any of the
above criteria for RespiGamTM, should be considered for
monthly injections of SynagisTM.
In addition, monthly injections of SynagisTM should be
considered for infants of gestational age 28 weeks or less
even if they do not require home oxygen provided they are discharged
during RSV season (or shortly before) and are less than 6 months
old. These injections should begin at the onset of RSV season or,
if the infant is discharged from the hospital during RSV season, at
the time of discharge. Finally, any other infants born at or before
32 weeks gestation who are discharged during RSV season should be
considered for a single dose of SynagisTM at the time of
discharge.
Departures from these guidelines may be appropriate in individual
cases based on exposure risk, other confounding medical problems, and
other factors. The presence of a cardiac lesion with
systemic-to-pulmonary shunting increases the risk of a complicated
course with RSV infection; infants with such lesions should be
considered for prophylaxis with SynagisTM or
RespiGamTM.
References
Groothuis JR, Simoes EAF, Hemming VG, et al. Prophylactic
administration of respiratory syncytial virus (RSV) immune globulin
in high risk infants and young children. N Engl J Med. 1993;
329:1524-30.
RespiGamTM Product Information. MedImmune, Inc.
Gaithersburg, MD. 1996 (January).
Impact-RSV Study Group. Palivizumab, a humanized respiratory
syncytial virus monoclonal antibody, reduces hospitalization from
respiratory syncytial virus infection in high-risk infants.
Pediatrics. 1998; 102:531-7.
SynagisTM Product Information. MedImmune, Inc.
Gaithersburg, MD. 1998 (19 June).
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