Counseling for Bronchiolitis Prevention in a 29-Week Premature Infant
This infant qualifies for palivizumab (Synagis) prophylaxis based on gestational age alone and should receive monthly injections throughout RSV season to prevent severe bronchiolitis. 1, 2
Palivizumab Prophylaxis Recommendation
Your 29-week premature infant meets criteria for RSV prophylaxis regardless of other risk factors. 1, 2
Key prophylaxis details:
- Administer 5 monthly intramuscular injections at 15 mg/kg per dose 1, 3
- Begin before RSV season starts (typically November) and continue monthly through the season 1, 2, 3
- Palivizumab reduces RSV hospitalization risk by approximately 45-55% in high-risk infants 2, 3
- Continue prophylaxis throughout the entire RSV season even if the infant reaches 6 months of age during that time 1
Essential Prevention Measures Beyond Medication
Hand hygiene is the single most important preventive measure. 1, 4
Specific hygiene instructions:
- Use alcohol-based hand rubs or antimicrobial soap before and after touching the infant 1, 2
- All family members and visitors must practice strict hand decontamination 1, 4
Environmental and exposure modifications:
- Completely eliminate tobacco smoke exposure - this is a controllable risk factor that significantly increases RSV hospitalization risk 1, 2
- Avoid crowds and limit group childcare attendance during RSV season (November through March in most regions) 1, 2
- Minimize contact with individuals who have respiratory infections 1
- Keep the infant away from school-aged siblings when they are ill 1
Additional protective measures:
- Encourage exclusive breastfeeding to decrease lower respiratory tract disease risk 1, 2
- Ensure influenza vaccination for the infant starting at 6 months and all household contacts 1, 2
What NOT to Do
Regarding the answer choices provided:
- Option B (oral antibiotics) is INCORRECT - antibiotics have no role in bronchiolitis prevention and should only be used if bacterial co-infection develops 1, 4, 5
- Option D (reassurance alone) is INADEQUATE - this high-risk infant requires active prophylaxis with palivizumab, not just reassurance 1, 2, 3
- Option A (cough as transmission source) - while RSV spreads through respiratory droplets, the critical counseling point is implementing the prevention strategies above, not just discussing transmission 1, 2
Critical Pitfalls to Avoid
Do not delay palivizumab initiation. The first dose must be given before RSV season begins to provide protection when exposure risk is highest. 2, 3
Do not discontinue prophylaxis early. Even if the infant appears healthy or reaches 6 months of age mid-season, continue all 5 monthly doses throughout the entire RSV season. 1
Watch for severe allergic reactions including rash, hives, lip/tongue/face swelling, difficulty breathing, or bluish skin color after palivizumab administration. 2, 3