What medication could have prevented death in a 2-month-old girl with bronchopulmonary dysplasia, presenting with fever, respiratory distress, and hypoxemia, who was born preterm at 28 weeks gestation?

From the Guidelines

The most likely intervention that could have prevented this patient's death is palivizumab (option E). This infant had multiple risk factors for severe respiratory syncytial virus (RSV) infection, including prematurity (born at 28 weeks), low birth weight, young age (2 months), and bronchopulmonary dysplasia. The clinical presentation with fever, respiratory distress, wheezing, and hypoxemia during RSV season is highly consistent with RSV bronchiolitis, which can be fatal in high-risk infants. Palivizumab is a monoclonal antibody that provides passive immunity against RSV and is specifically indicated for prophylaxis in premature infants and those with chronic lung disease. It is typically administered monthly during RSV season (usually October through March in the Northern Hemisphere) at a dose of 15 mg/kg intramuscularly. The American Academy of Pediatrics recommends palivizumab prophylaxis for infants born before 29 weeks' gestation who are younger than 12 months at the start of RSV season and for infants with chronic lung disease of prematurity requiring medical therapy within 6 months before the start of RSV season, as stated in the clinical practice guideline 1. This patient clearly met these criteria but missed her recent appointment, which may have been scheduled for palivizumab administration. Timely prophylaxis with palivizumab could have prevented or significantly reduced the severity of RSV infection, potentially avoiding respiratory failure and death.

Some key points to consider in this case include:

• The patient's prematurity and low birth weight increase the risk of severe RSV infection
• The patient's diagnosis of bronchopulmonary dysplasia further increases the risk of severe RSV infection
• The patient's clinical presentation is consistent with RSV bronchiolitis
• Palivizumab prophylaxis is recommended for infants with chronic lung disease of prematurity, as stated in the clinical practice guideline 1
• The patient missed her recent appointment, which may have been scheduled for palivizumab administration, highlighting the importance of timely prophylaxis.

It is also worth noting that while vitamin A supplementation may have some benefits for premature infants, such as reducing the risk of chronic lung disease, it is not a substitute for palivizumab prophylaxis in preventing RSV infection, as stated in the study on vitamin A supplementation 1. Therefore, palivizumab (option E) is the most likely intervention that could have prevented this patient's death.

From the FDA Drug Label

Synagis is indicated for the prevention of serious lower respiratory tract disease caused by respiratory syncytial virus (RSV) in pediatric patients: with a history of premature birth (less than or equal to 35 weeks gestational age) and who are 6 months of age or younger at the beginning of RSV season, with bronchopulmonary dysplasia (BPD) that required medical treatment within the previous 6 months and who are 24 months of age or younger at the beginning of RSV season, with hemodynamically significant congenital heart disease (CHD) and who are 24 months of age or younger at the beginning of RSV season

The patient in question is a 2-month-old girl born at 28 weeks' gestation with a history of bronchopulmonary dysplasia (BPD) and weighing 2118 g (4 lb 11 oz). Given her premature birth and BPD diagnosis, she meets the criteria for Palivizumab (Synagis) administration. Palivizumab is likely to have prevented this patient's death, as it is indicated for the prevention of serious lower respiratory tract disease caused by RSV in high-risk pediatric patients, such as those with BPD 2.

From the Research

Patient Profile

• The patient is a 2-month-old girl with a history of prematurity (born at 28 weeks' gestation) and bronchopulmonary dysplasia (BPD)
• She was admitted to the hospital with fever, difficulty breathing, and nasal congestion
• Her condition deteriorated, and she required mechanical ventilatory support, but unfortunately, she died after 4 days in the pediatric intensive care unit

Relevant Studies

• Studies 3, 4, 5, 6, 7 suggest that palivizumab, a humanized monoclonal antibody, can reduce the incidence of hospitalization due to respiratory syncytial virus (RSV) infection in high-risk infants, including those with prematurity and BPD
• The studies show that palivizumab prophylaxis can significantly reduce RSV-related hospitalizations, intensive care unit admissions, and the need for mechanical ventilation

Potential Prevention of Death

• Based on the patient's profile and the studies mentioned, administration of palivizumab may have prevented the patient's death
• The patient's high-risk status due to prematurity and BPD makes her a potential candidate for palivizumab prophylaxis
• The studies suggest that palivizumab can reduce the severity of RSV infection and prevent hospitalization, which may have improved the patient's outcome

Key Findings

• Palivizumab has been shown to be effective in reducing RSV-related hospitalizations in high-risk infants, including those with prematurity and BPD 3, 4, 5, 7
• The medication has a good safety profile and is well-tolerated in high-risk infants 3, 4, 5, 6
• The use of palivizumab may be beneficial in preventing severe RSV infections in high-risk infants, including those with prematurity and BPD 3, 4, 5, 6, 7