RSV Prophylaxis for a 2-Month-Old Born in September
A 2-month-old infant born in September does NOT routinely qualify for palivizumab (RSV prophylaxis) unless they meet specific high-risk criteria: born before 29 weeks gestation, have chronic lung disease requiring medical therapy, have hemodynamically significant congenital heart disease, or have other qualifying conditions. 1, 2
Risk Stratification Algorithm
The decision to administer palivizumab depends entirely on the infant's gestational age at birth and presence of underlying medical conditions, NOT simply their chronological age:
Infants Who SHOULD Receive Prophylaxis:
Born at <29 weeks, 0 days gestation and currently <12 months old at RSV season start (November): These infants qualify regardless of other risk factors 1, 2
Chronic lung disease (CLD): Infants <24 months who required medical therapy (supplemental oxygen, bronchodilators, diuretics, or corticosteroids) within 6 months before RSV season 1
Hemodynamically significant congenital heart disease: Children <24 months receiving medication for congestive heart failure, with moderate-to-severe pulmonary hypertension, or with cyanotic heart disease 1, 3
Infants Born 29-31 Weeks, 6 Days Gestation:
For an infant born in September at 29-31 weeks gestation, they would receive 2 doses if they are <6 months old at the start of RSV season (November 1) 1
Infants Born 32-34 Weeks, 6 Days Gestation:
These infants qualify ONLY if they have specific risk factors (attends childcare OR has a sibling <5 years old) AND are <90 days old at RSV season start 1
- An infant born in September at 32-34 weeks would be approximately 2 months old in November, qualifying for 2 doses if risk factors are present 1
Term or Late Preterm Infants (≥35 Weeks):
Do NOT qualify for routine palivizumab prophylaxis unless they have CLD, congenital heart disease, or other qualifying medical conditions 1, 4
Dosing Protocol When Indicated
Standard dose: 15 mg/kg intramuscularly every 30 days throughout RSV season 2, 3, 4
Timing: First dose should be administered in November (or before RSV season starts), with subsequent monthly doses 1, 2
Maximum doses: 5 doses for most infants, though infants born 32-34 weeks with risk factors may receive fewer doses (1-3) depending on birth month 1
Critical Pitfalls to Avoid
Do not administer palivizumab based solely on chronological age. The 2014 AAP guidelines significantly restricted palivizumab use compared to earlier recommendations, emphasizing that the vast majority of RSV hospitalizations occur in healthy term infants who do NOT qualify for prophylaxis 1
Do not use palivizumab for treatment of active RSV infection—it has no therapeutic efficacy and is only approved for prevention 1, 2, 4
Do not assume all premature infants qualify. Infants born at ≥29 weeks without additional risk factors generally do not meet criteria for prophylaxis 1
Do not continue prophylaxis after a breakthrough RSV hospitalization during the same season, as the likelihood of a second RSV hospitalization is extremely low (<0.5%) 1
Additional Context for September Birth
An infant born in September will be 2 months old in November when RSV season typically begins. This timing is relevant because:
- If born at <29 weeks gestation: Qualifies for 5 doses starting in November 1, 2
- If born at 29-31 weeks gestation: Qualifies for 2 doses (will be <6 months at season start) 1
- If born at 32-34 weeks gestation: May qualify for 2 doses only if risk factors present (childcare attendance or sibling <5 years) 1
- If born ≥35 weeks gestation: Does not qualify unless CLD or congenital heart disease present 1
The key determination is gestational age at birth and presence of qualifying medical conditions, not the month of birth alone.