Review of palivizumab prescribing in neonates during two consecutive respiratory syncytial virus seasons

Introduction: Palivizumab is used to prevent high risk neonatal patients from contracting

respiratory syncytial virus (RSV). The American Academy of Pediatrics (AAP) updated

the palivizumab prophylaxis prescribing guidelines between the 2013-2014 and 2014-

2015 RSV seasons.

Objectives: The primary objective of this study is to determine if providers followed

current guidelines for prescribing palivizumab administered during 2 subsequent RSV

seasons.

Study Design: This study is a retrospective cohort comparing the 2013-2014 and 2014-

2015 RSV seasons for compliance to the guidelines, defined by AAP recommendations

for prescribing palivizumab.

Methods: Medical records of 88 neonatal patients admitted to Cabell Huntington Hospital

who received a dose of palivizumab during their inpatient Neonatal Intensive Care Unit

admission between 11/4/13 and 3/10/15 were reviewed. Patient’s birth date, date and

dose of palivizumab, gestational age at birth, sibling status, oxygen requirements,

vasopressor therapy, and the medical conditions bronchopulmonary dysplasia and

respiratory distress syndrome were documented.

Results: There were a greater number of total doses of palivizumab given in the 2013-

2014 RSV season than the 2014-2015 RSV season (63 doses vs. 25 doses) suggesting

that overall prescribing for palivizumab decreased after implementation of the 2014 AAP

guidelines. The percentage of doses given per AAP guidelines decreased

from the 2013-2014 RSV season to the 2014-2015 RSV season (86% vs. 60%). Two out

of ten palivizumab doses given in the 2014-2015 RSV season did not meet either the

2010 or the 2014 AAP guidelines.

Conclusions: Prescribers followed the previous 2010 AAP guidelines more often than the

updated 2014 AAP guidelines when utilizing palivizumab in neonates. This may be due

to lack of familiarity with the new AAP guidelines or concern that the updated AAP

guidelines are too stringent. More research is needed to review patient outcomes, such as

RSV diagnosis, re-admissions, and administration of follow-up doses of palivizumab.