RSV Prevention and Treatment in Newborns
For newborns with RSV, treatment is primarily supportive while prevention focuses on palivizumab prophylaxis for high-risk infants, with specific eligibility criteria established by the American Academy of Pediatrics. 1, 2
Prevention Strategies for High-Risk Infants
Palivizumab Prophylaxis Eligibility
- Palivizumab is recommended for infants born before 29 weeks, 0 days' gestation who are younger than 12 months at the start of RSV season 1, 2
- Infants with chronic lung disease who received medical therapy within 6 months before the start of the RSV season 2
- Infants with hemodynamically significant congenital heart disease who are 24 months of age or less 1, 3
- Children with pulmonary abnormality or neuromuscular disease that impairs the ability to clear secretions from the upper airways 1, 2
Palivizumab Administration
- The recommended dose is 15 mg/kg body weight given monthly by intramuscular injection 1, 3
- Maximum of 5 doses during RSV season for most eligible infants 1, 2
- Hospitalized infants who qualify for prophylaxis should receive the first dose 48 to 72 hours before discharge or promptly after discharge 4, 2
- For children who undergo cardiac bypass, an additional dose should be administered after the procedure due to a 58% decrease in palivizumab serum concentration 4, 2
Efficacy of Palivizumab
- Provides a 55% overall decrease in RSV-related hospitalization in premature infants and those with chronic lung disease 1, 3
- 45% decrease in RSV-related hospitalization in infants with hemodynamically significant congenital heart disease 1, 3
- Does not treat established RSV disease or reduce mortality from RSV infection 5, 3
General Preventive Measures
- Keep high-risk infants away from crowds and situations where exposure to infected people cannot be controlled 1, 2
- Restrict participation in group child care during RSV season when feasible 1, 2
- Practice careful hand hygiene 1, 2
- Ensure all eligible infants and their contacts receive influenza vaccine and other age-appropriate immunizations 1, 2
- Eliminate exposure to tobacco smoke 4, 1
Treatment of RSV Infection
- Treatment for RSV infection is primarily supportive care, as there are no specific antiviral treatments approved for RSV in newborns 6
- If a child receiving monthly palivizumab prophylaxis experiences a breakthrough RSV infection, monthly prophylaxis should continue until the maximum number of doses have been administered 4
- For infants in the 32-34 weeks' gestational age group, continue prophylaxis until a maximum of 3 doses have been administered 4
- For infants with chronic lung disease, congenital heart disease, or born before 32 weeks' gestation, continue prophylaxis until a maximum of 5 doses have been administered 4
Common Pitfalls to Avoid
- Failure to administer an additional dose of palivizumab after cardiac bypass surgery 1, 2
- Inappropriate use of palivizumab in infants with hemodynamically insignificant heart disease (e.g., secundum atrial septal defect, small ventricular septal defect) 4
- Discontinuing prophylaxis prematurely before the end of RSV season 1, 2
- Neglecting general preventive measures while relying solely on pharmacological prophylaxis 1, 2
- Using palivizumab for treatment of established RSV disease, as it is only effective for prevention 2, 5