What is the appropriate preventive measure for RSV/bronchiolitis in a 2‑month‑old infant born at 29 weeks gestation who is otherwise healthy?

Palivizumab Prophylaxis is Recommended for This Infant

This 2-month-old infant born at 29 weeks gestation qualifies for palivizumab prophylaxis and should receive it to prevent severe RSV disease. 1, 2, 3

Why This Infant Qualifies

• Infants born before 29 weeks, 0 days' gestation who are younger than 12 months at the start of RSV season may receive palivizumab prophylaxis 1
• This infant was born at exactly 29 weeks, which places him at the threshold where prophylaxis may be administered 1, 2
• The American Academy of Pediatrics specifically states that palivizumab prophylaxis may be administered to infants born before 29 weeks, 0 days' gestation 1, 2, 3
• At 2 months of age (corrected age approximately 1 week), this infant is well within the eligible age range 2, 3

Administration Protocol

Palivizumab should be given as 15 mg/kg intramuscularly once monthly throughout RSV season, with a maximum of 5 doses 2, 3, 4

• The first dose should be administered before or at the start of RSV season (typically November-December in most regions) 3
• If RSV season has already started, administer the first dose as soon as possible 4
• Continue monthly injections every 28-30 days throughout the RSV season 2, 4
• Each injection provides protection for approximately 1 month 4

Expected Benefit

• Palivizumab reduces RSV hospitalization risk by approximately 45-55% in high-risk infants 3, 5
• The benefit is limited to prevention of hospitalization; palivizumab has no measurable effect on mortality and minimal effect on subsequent wheezing 1
• Palivizumab is ONLY for prevention, not treatment of established RSV infection 5, 4

Essential Non-Pharmacologic Prevention Measures

In addition to palivizumab, the following measures are critical for all high-risk infants:

• Complete elimination of tobacco smoke exposure 2, 5
• Avoid crowds and situations where exposure to infected people cannot be controlled 2, 5
• Restrict group child care participation during RSV season when feasible 2, 5
• Strict hand hygiene by all caregivers and family members 2, 5
• Encourage breastfeeding to decrease risk of lower respiratory tract disease 3, 5
• Ensure influenza vaccination for all household contacts (infant can receive at 6 months) 3, 5

Important Safety Information

• Severe allergic reactions including anaphylaxis can occur with palivizumab 3, 4
• Signs of severe allergic reaction include: severe rash, hives, swelling of lips/tongue/face, difficulty breathing, bluish skin color, or unresponsiveness 4
• The most common side effects are fever and rash 4
• If the infant experiences a breakthrough RSV hospitalization despite prophylaxis, monthly palivizumab should be discontinued as the likelihood of a second RSV hospitalization in the same season is extremely low 2

Why Other Options Are Incorrect

• Reassurance alone (Option A) is inadequate because this infant meets criteria for prophylaxis and would miss an opportunity for risk reduction 1, 2
• Antibiotics (Option C) have no role in RSV prevention and should only be used when specific bacterial co-infection is documented 5
• Cough transmission education (Option D) is important but insufficient as the primary intervention when prophylaxis is indicated 2, 5