Abstract
BACKGROUND: Palivizumab, a monoclonal antibody against Respiratory Syncytial Virus (RSV), is effective in decreasing RSV related hospitalizations in preterm infants. However, ensuring that infants receive their desired monthly injections remains a challenge. In an urban inner city population, home health visits to administer the monthly injections are complicated by the fact that many families either do not have a phone or frequently change their residence. In some cases there is significant delay involved in getting authorization from Medicaid health maintenance organizations to have home visits.
OBJECTIVE: To determine the compliance with RSV prophylaxis in a high risk urban inner city population by incorporating it as a part of health maintenance visits in the high risk follow-up clinic.
DESIGN/METHODS: Medical records were reviewed for the number of doses of palivizumab administered, incidence and number of hospitalizations for RSV related illness in a cohort of infants during the RSV season from November 2004 to April 2005 at Sinai Children's Hospital. All infants discharged from the neonatal intensive care unit (NICU) are followed up in a high risk clinic. This clinic offers comprehensive medical care for the high risk children including health maintenance visits. Palivizumab (15mg/kg) was given as monthly injections to qualifying infants (guidelines from American Academy of Pediatrics) at this high risk follow-up clinic. Neonates discharged during the RSV season received their first injection prior to discharge from the NICU.
RESULTS: During the study period, 72 infants qualified for palivizumab administration. The mean birth weight was 1620 grams (range 560-3490) and the mean gestational age was 31.1 weeks (range 24-39). 46 infants (63.7%) got all the recommended doses and 20 infants (26.3%) got 80% of the recommended doses. Only 6 infants (9%) received fewer than 80% of the recommended doses. During the study period there were two documented RSV infections and one of the infants was hospitalized. This infant required oxygen by nasal cannula and albuterol nebulization only.
CONCLUSIONS: This model of administration of palivizumab resulted in 91% of infants receiving >80% of the recommended doses. Hence this model is a viable alternate to the home health model to administer palivizumab in an inner city population.
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Srinivasan, H., Srinivasan, G. 51 A Model for RSV Prophylaxis in an Urban Inner City Hospital.. Pediatr Res 60, 499 (2006). https://doi.org/10.1203/00006450-200610000-00073
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DOI: https://doi.org/10.1203/00006450-200610000-00073