Objective To evaluate why certain premature infants were hospitalized for respiratory syncytial virus (RSV) despite receiving palivizumab.
Methods All premature infants ≤ 35 weeks gestational age (GA) who received palivizumab at the University of California Irvine Medical Center during the 2003-2004 and 2004-2005 seasons were identified. Those who were hospitalized for RSV were identified as subjects. For each patient hospitalized, two random controls with the same gestational age born within 2 months of the subject were chosen. The controls had also received palivizumab but were not hospitalized. The charts of the patients and controls were reviewed to identify risk factors that may have contributed to hospitalization.
Results 250 infants ≤ 35 weeks gestational age had received palivizamub at UCIMC during the 2-year period. Of these, 6 patients were hospitalized and 5 of 6 were born at < 29 weeks' gestation. All 6 patients had received palivizumab according to the guidelines published by the American Academy of Pediatrics. The mean number of palivizumab injections prior to hospitalization was 2.8 and the mean time interval between the last palivizumab injection and hospitalization was 15.5 days. All of the very premature patients and controls (< 29 weeks GA) had chronic lung disease but compared to controls, all those hospitalized had other complications, such as tracheostomy, congenital anomalies, or severe intraventricular hemorrhage.
Conclusions Congenital anomalies or severe intraventricular hemorrhage may be contributing risk factors for very premature infants who are hospitalized for RSV despite receiving palivizumab. Larger studies are needed to further identify these contributing risk factors and evaluate control measures to further decrease hospitalization rates in premature infants.
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