Comparison of the timing of initial prophylactic palivizumab dosing on hospitalization of neonates for respiratory syncytial virus.

ABSTRACT

PURPOSE: The effects of two prophylactic palivizumab schedules on hospitalization of neonates for respiratory syncytial virus (RSV) were compared. METHODS: This retrospective study was conducted in the neonatal intensive care unit (NICU) of a tertiary care, academic medical center. Patients were divided into two groups. Group 1 (hospitalized between October 2005 and April 2007) received inpatient doses of palivizumab monthly throughout the RSV season, regardless of their anticipated discharge date, followed by outpatient doses. Group 2 (hospitalized between October 2007 and April 2009) received only one dose of palivizumab before hospital discharge with subsequent outpatient doses. The primary outcome measure was the number of hospitalizations for RSV bronchiolitis. Secondary endpoints included the total number of palivizumab doses each patient received, number of inpatient doses per patient, number of hospitalizations requiring intensive care unit admission, patient need for mechanical ventilation, outcome of the RSV-related hospitalization, and cost of inpatient palivizumab doses per patient. RESULTS: A total of 207 neonates were included in the study (112 in group 1, 95 in group 2). The mean gestational age was 29.7 weeks in group 1 and 30.3 weeks in group 2. Seven patients were hospitalized for RSV infection (5 in group 1 versus 2 in group 2, p = 0.4564). No RSV-related deaths occurred. Significantly more inpatient doses were administered to group 1 versus group 2 (1.7 versus 1, p < 0.001). Limiting inpatient palivizumab to 1 dose before discharge resulted in an institutional cost savings of more than $60,000 annually. CONCLUSION: Hospitalization rates for RSV did not significantly differ between NICU patients who received inpatient prophylactic palivizumab monthly and those who received only one dose before discharge.