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.
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.
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.
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