II. Indications: RSV Prophylaxis (AAP guidelines, 2014)

  1. Congenital airway, pulmonary or neuromuscular disorder interfering with secretion clearance in age <12 months
  2. Hemodynamically significant Congenital Heart Disease in age <12 months
  3. Severe Immunodeficiency in age <24 months
  4. Preterm Infants with Gestational age at birth <29 weeks and age <12 months
  5. Chronic lung disease of prematurity
    1. Age <12 months
      1. Gestational age <32 weeks AND
      2. Required Supplemental Oxygen >21% for at least 28 days after delivery
    2. Age <24 months
      1. Treatment (oxygen, broncodilators, steroids, Diuretics) within 6 months of RSV season start
  6. Cystic Fibrosis
    1. Age <12 months
      1. Findings of chronic lung disease or nutritional deficiency
    2. Age <24 months
      1. Weight for Length below 10th percentile OR
      2. Severe lung disease (respiratory related hospitalization in age <1 year or persistent CXR changes)

III. Mechanism

  1. Humanized mouse Monoclonal Antibody to RSV
  2. Provides passive Immunity to RSV in high risk infants

IV. Dosing

  1. Palivizumab 15 mg/kg IM monthly for up to 5 months of RSV season
  2. Historically RSV season has been November 1 to March 1 in U.S.
    1. However post-2020 Covid, peak RSV season has shifted to spring-summer

V. Efficacy

  1. Decreases hospitalizations by 45 to 55%
  2. NNT 18 to prevent one RSV related hospitalization
  3. Does not decrease RSV related mortality

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