Monthly Palivizumab Prophylaxis is Indicated
This 2-month-old infant born at 29 weeks gestation qualifies for palivizumab prophylaxis and should receive monthly intramuscular injections throughout the RSV season—reassurance alone is inadequate and forgoes a proven opportunity to reduce RSV hospitalization risk by approximately 45-55%. 1, 2
Why This Infant Qualifies for Palivizumab
Infants born at 29 weeks gestation are eligible for palivizumab based on gestational age alone, even without chronic lung disease, and should receive prophylaxis during their first RSV season whenever that occurs during the first 12 months of life. 1
The American Academy of Pediatrics specifically recommends palivizumab for infants born before 29 weeks, 0 days' gestation who are younger than 12 months at the start of RSV season. 2
This infant, now 2 months old and born at 29 weeks, falls squarely within these criteria regardless of current oxygen status. 1, 2
Administration Protocol
Palivizumab is given as 5 monthly intramuscular injections at 15 mg/kg per dose, typically beginning in November or December and continuing throughout RSV season. 1, 3
The first dose should be administered before RSV season starts to provide protection when exposure risk is highest, or as soon as possible if the season has already begun. 1, 3
Each injection provides protection for approximately one month, making compliance with the full monthly schedule critical. 3
Expected Clinical Benefit
Palivizumab reduces RSV hospitalization risk by approximately 45-55% in high-risk infants like this one. 1, 2
Very preterm infants (<29 weeks) have a 3-4 times higher relative risk of RSV hospitalization compared to term infants, with more frequent ICU admissions and mechanical ventilation when hospitalized. 4
Palivizumab reduces hospitalization but does not affect mortality and has minimal impact on subsequent wheezing—its benefit is limited to preventing hospital admission. 2
Why Other Options Are Incorrect
Option A (Reassure): Providing only reassurance is inadequate because it forgoes a proven intervention that significantly reduces hospitalization risk in an eligible high-risk infant. 2
Option C (Antibiotics): Antibiotics have no role in RSV prevention and should only be used when specific bacterial co-infection is documented. 5, 6
Option D (Cough transmission): While RSV is transmitted through respiratory droplets and contact with contaminated surfaces (not primarily through cough as a route), this does not constitute appropriate counseling for prevention in a high-risk infant who qualifies for pharmacologic prophylaxis. 7, 8
Essential Adjunctive Prevention Measures
Beyond palivizumab, counsel the family on these critical non-pharmacologic interventions:
Hand hygiene is critical—hands should be decontaminated before and after contact with the infant using alcohol-based rubs or antimicrobial soap. 1, 6
Avoid tobacco smoke exposure completely, as it is a controllable risk factor that significantly increases RSV hospitalization risk. 1, 2
Limit exposure to crowds and group childcare during RSV season (November through March in most regions). 1, 2
Encourage continued breastfeeding to decrease the risk of lower respiratory tract disease. 1, 6
Ensure influenza vaccination for all household contacts (infant can receive vaccine starting at 6 months). 1, 2
Common Pitfalls to Avoid
Do not withhold palivizumab simply because the infant is "doing well" and off oxygen—eligibility is based on gestational age at birth and current chronologic age, not current clinical status. 1, 2
Do not delay the first dose—protection is time-sensitive and should begin before or early in RSV season. 1, 3
Do not confuse palivizumab with treatment—it is purely prophylactic and has no therapeutic benefit for established RSV infection. 2, 6