II. Indications: RSV Prophylaxis (AAP guidelines, 2014)
- Congenital airway, pulmonary or neuromuscular disorder interfering with secretion clearance in age <12 months
- Hemodynamically significant Congenital Heart Disease in age <12 months
- Severe Immunodeficiency in age <24 months
- Preterm Infants with Gestational age at birth <29 weeks and age <12 months
- Chronic lung disease of prematurity
- Age <12 months
- Gestational age <32 weeks AND
- Required Supplemental Oxygen >21% for at least 28 days after delivery
- Age <24 months
- Treatment (oxygen, broncodilators, steroids, Diuretics) within 6 months of RSV season start
- Age <12 months
-
Cystic Fibrosis
- Age <12 months
- Findings of chronic lung disease or nutritional deficiency
- Age <24 months
- Weight for Length below 10th percentile OR
- Severe lung disease (respiratory related hospitalization in age <1 year or persistent CXR changes)
- Age <12 months
III. Mechanism
- Humanized mouse Monoclonal Antibody to RSV
- Provides passive Immunity to RSV in high risk infants
IV. Dosing
- Palivizumab 15 mg/kg IM monthly for up to 5 months of RSV season
- Historically RSV season has been November 1 to March 1 in U.S.
- However post-2020 Covid, peak RSV season has shifted to spring-summer
V. Efficacy
- Decreases hospitalizations by 45 to 55%
- NNT 18 to prevent one RSV related hospitalization
- Does not decrease RSV related mortality
VI. Resources
- Palivizumab Injection Solution (DailyMed)
VII. References
- Pickering (2009) Red Book, AAP, Elk Grove Village, p. 560
- (2014) Pediatrics 134(2): e620-38 [PubMed]
- Gargnani (2021) Cochrane Database Syst Rev 11(11):CD013757 +PMID: 34783356 [PubMed]