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Respiratory Syncytial Virus (RSV) Immunoglobulin Prophylaxis in High Risk Neonates: Survey of US Neonatologists † 1274

RSV is a common viral pathogen that infects young children. Premature infants and children with chronic lung disease are at the highest risk for severe infections. In 1996 the FDA licensed a high titer RSV immunoglobin for immunoprophylaxis. In April 1997 the Committee on Infectious Diseases of the American Academy of Pediatrics published indications for RSV-IVIG use. The guidelines were broad and had to be interpreted by the clinician because RSV-IVIG was both costly and time consuming. Methods: In an effort to evaluate the implementation of these guidelines nationwide, we surveyed 1440 Neonatologists (NEO) who were members of the Section on Perinatal Pediatrics of the American Academy of Pediatrics. Results: A total of 398 (28%) surveys were returned and evaluated. All regions of the country and 48/50 states were represented. Primary work-site listed by the respondents was a community hospital (CH) 63.4% and university based (UH) 36.6%. A majority of the respondents worked in a Level 3/4 NICU (83.6%). The median number of <32 week gestational age (GA) infants admitted was 70 and 120 for CH and UH respectively. 314/398 respondents recommended RSV-IVIG prophylaxis during 1996-97. Guidelines for RSV-IVIG use were primarily formulated by NEO(47.6%) or by a group including Pediatric ID, NEO and others (45.6%). The most common guidelines were: infants with active BPD (95%), infants with BPD <24 months of age (50%), <32 weeks GA (31%) and infants with congenital heart disease (14.6%). Of 10 available criteria, use varied among respondents ranging from 1-8. Approximately 70% of the respondents administered RSV-IVIG prior to discharge from the NICU. Outpatient programs for RSV-IVIG administration were associated with NEO based in CH more than in UH (59% and 41%, respectively)and were run by general pediatricians and/or pediatric ID, 27% and 12%, respectively. Ambulatory clinics were the most common site of RSV-IVIG administration (73%). Home infusions were noted by 13% of respondents. 6127/42791 infants (14%) <32 weeks GA received RSV-IVIG prophylaxis. There were no Regional (Northeast, Southeast, etc) differences in the respondents answers. Conclusion: The low percentage of infants receiving RSV-IVIG suggests some risk assessment was used in screening. Despite RSV-IVIG not being approved for use in children with congenital heart disease, nearly 15% of NEO used CHD as a criteria for use. There is no clear consensus among neonatologists regarding criteria for RSV-IVIG prophylaxis in infants without active BPD.