What preventive measure should be given to a 2‑month‑old former‑preterm infant born at 29 weeks gestation, now healthy, to prevent RSV/bronchiolitis?

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Last updated: February 13, 2026 • View editorial policy

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Palivizumab Prophylaxis for RSV Prevention

This 2-month-old former 29-week preterm infant qualifies for palivizumab prophylaxis and should receive it—the answer is B. 1, 2

Why Palivizumab Is Indicated

Infants born before 29 weeks, 0 days' gestation who are younger than 12 months at the start of RSV season are eligible for palivizumab prophylaxis based on gestational age alone, regardless of current health status. 1, 2 This infant, born at 29 weeks and now 2 months old (corrected age approximately term), falls squarely within this high-risk category. 1

  • The American Academy of Pediatrics specifically recommends palivizumab for all infants born at ≤28 weeks gestation during their first RSV season, whenever that occurs during the first 12 months of life. 2, 3
  • Even though this infant is now healthy with a normal examination and off oxygen, the prematurity itself (29 weeks) confers sufficient risk to warrant prophylaxis. 1, 2

Clinical Benefit and Limitations

Palivizumab reduces RSV-related hospitalization risk by approximately 45-55% in high-risk infants, though it does not affect mortality and has minimal impact on subsequent wheezing. 1, 2 The benefit is specifically in preventing hospital admission for severe RSV disease. 1

  • Palivizumab is only for prevention, never for treatment of established RSV infection. 4, 5
  • The mother's concern about "bronchitis" (likely referring to RSV bronchiolitis) is precisely what palivizumab is designed to prevent. 1, 2

Administration Protocol

The recommended regimen is 15 mg/kg intramuscularly monthly throughout RSV season, with a maximum of 5 doses. 1, 2, 5

  • The first dose should be given 48-72 hours before hospital discharge or promptly after discharge if the infant qualifies during RSV season. 1, 2
  • Since this infant is presenting for a vaccination appointment (presumably already discharged from NICU), the first dose should be administered immediately. 1, 2
  • Doses continue monthly (every 28-30 days) throughout the RSV season (typically November through March, though this varies by region). 2, 5

Why Other Options Are Incorrect

Reassurance alone (Option A) is inadequate and represents a missed opportunity to reduce severe RSV disease risk in a clearly eligible high-risk infant. 1 The American Academy of Pediatrics explicitly states that providing only reassurance when an infant meets eligibility criteria forgoes proven preventive benefit. 1

  • Antibiotics (Option C) have no role in RSV prevention and should only be used when specific bacterial co-infection is documented. 4, 6
  • Cough as a route of transmission (Option D) is not a preventive intervention—RSV spreads via respiratory droplets and contact with contaminated surfaces, but this knowledge doesn't constitute a prevention strategy. 6, 3

Essential Adjunctive Prevention Measures

Beyond palivizumab, counsel the mother on critical non-pharmacologic measures: 1, 2

  • Complete elimination of tobacco smoke exposure is essential and increases RSV hospitalization risk. 1, 2
  • Avoid crowds and situations where exposure to infected people cannot be controlled, especially during RSV season. 1, 2
  • Restrict group childcare participation during RSV season when feasible. 1, 2
  • Practice strict hand hygiene by all caregivers and family members. 1, 2
  • Ensure influenza vaccination for all household contacts (infant can receive at 6 months). 1, 2
  • Continue breastfeeding to potentially decrease lower respiratory tract disease risk. 2, 4

Common Pitfall

The most critical error would be withholding palivizumab because the infant appears healthy now. 1 The eligibility is based on gestational age at birth and chronologic age at RSV season onset, not current clinical status. 1, 2 Former preterm infants remain at elevated risk for severe RSV disease throughout their first year despite appearing well. 6, 3

References

1
Guideline

RSV Prophylaxis Guidelines for High-Risk Infants

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

2
Guideline

Palivizumab Prophylaxis for RSV Prevention in High-Risk Infants

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2025

3
Research

Respiratory Syncytial Virus Bronchiolitis in Children.

American family physician, 2017

4
Guideline

Respiratory Syncytial Virus Infection Management

Praxis Medical Insights: Practical Summaries of Clinical Guidelines, 2026

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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