Should a 2-month-old infant born at 36 weeks and 6 days receive palivizumab (Respiratory Syncytial Virus (RSV) prophylaxis)?

RSV Prophylaxis for a 2-Month-Old Born at 36 Weeks and 6 Days

This infant does NOT qualify for palivizumab (RSV prophylaxis) based on gestational age alone, as they were born at 36 weeks and 6 days, which exceeds the 34 weeks and 6 days cutoff for routine prophylaxis. 1

Gestational Age Criteria

The American Academy of Pediatrics defines eligibility for palivizumab based on precise gestational age thresholds 1:

• Infants born before 29 weeks, 0 days' gestation who are younger than 12 months at the start of RSV season qualify for up to 5 doses 1, 2
• Infants born 29 weeks, 0 days through 31 weeks, 6 days' gestation who are younger than 6 months at the start of RSV season qualify for up to 5 doses 1
• Infants born 32 weeks, 0 days through 34 weeks, 6 days' gestation qualify ONLY if they meet specific risk factors AND are within 90 days of age, receiving a maximum of 3 doses 1

Your infant at 36 weeks and 6 days gestation falls outside all these categories. 1

Why This Infant Does Not Qualify

The AAP guidelines specifically state that infants born at 32 weeks 0 days through 34 weeks 6 days represent the upper gestational age limit for consideration, and even these infants require additional risk factors 1. The previous definition that included infants up to 35 weeks 0 days was changed in 2009 1, 3. An infant born at 36 weeks and 6 days is considered "late preterm" but does not meet criteria for palivizumab prophylaxis based on prematurity alone. 1

Exceptions That Would Qualify This Infant

This infant would qualify for palivizumab prophylaxis ONLY if they have one of the following high-risk conditions 1, 2, 4:

• Chronic lung disease (CLD) requiring medical therapy (supplemental oxygen, bronchodilators, diuretics, or corticosteroids) within 6 months before RSV season and are less than 24 months of age 1, 2
• Hemodynamically significant congenital heart disease requiring medication for congestive heart failure, moderate-to-severe pulmonary hypertension, or cyanotic heart disease in children less than 24 months of age 1, 2
• Congenital abnormalities of the airway or neuromuscular disease that compromises handling of respiratory secretions 1, 2, 4

Alternative Prevention Strategies

Since this infant does not qualify for palivizumab, focus on general preventive measures 1, 2:

• Keep the infant away from crowds and situations where exposure to infected people cannot be controlled during RSV season (typically November through March) 1, 2
• Restrict participation in group child care during RSV season when feasible 1, 2
• Practice meticulous hand hygiene for all caregivers and household contacts 1, 2
• Eliminate all exposure to tobacco smoke, as this is a known risk factor for severe RSV disease 1, 2
• Ensure all household contacts receive influenza vaccine and that the infant receives age-appropriate immunizations starting at 6 months 1, 2

Common Pitfall to Avoid

Do not confuse the FDA labeling language stating palivizumab is indicated for infants "born prematurely (at or before 35 weeks)" with current AAP guidelines 3. The AAP guidelines are more restrictive and evidence-based, limiting prophylaxis to infants born at 34 weeks 6 days or earlier (with additional criteria for those 32-34 weeks 6 days). 1 The 2009 AAP policy statement specifically modified recommendations to target only children at highest risk of severe disease with the most consistent and predictive risk factors 1.