Impact of Palivizumab Immunization in Controlling Respiratory Syncytial Virus Infections Among Preterm Neonates After Hospital Discharge in the Tropics

Kok-Pim Kua, Nadia K Qureshi, Kon-Ken Wong, David Bin-Chia Wu, Shaun Wen-Huey Lee, Fook-Choe Cheah

Abstract

Background: Preterm neonates are at a greater risk of hospitalization for respiratory syncytial virus (RSV) infection and have significantly worse hospital outcomes compared with full-term neonates.

Aim: To determine the incidence of RSV respiratory tract infections (RTIs) among preterm neonates aged < 29 weeks and/or 1000 g birth weight under a controlled palivizumab immunization program

Materials and Methods: This was a prospective, observational cohort, single-center study. Preterm neonates, with or without palivizumab immunization, admitted to the NICU were monitored for 12 months after hospital discharge for RTI symptoms using a standard proforma through telephonic interview and further verification of hospital records. The presence of RSV was confirmed by real-time reverse transcription polymerase chain reaction on available nasal swab samples.

Results: A total of 196 neonates were enrolled, of whom 55 (28%) neonates were palivizumab immunized (PVI) and 141 (72%) were nonpalivizumab immunized (NPV). The mean gestation of PVI neonates was 28.7 ± 2.2 weeks and their mean birth weight was 1.14 ± 0.41 kg; 43.6% of these PVI neonates had bronchopulmonary dysplasia. Overall, PVI neonates tested lower for RSV throughout the study period compared with NPV neonates. The number of neonates who required rehospitalization was more in the PVI group than in the NPV group (30.9% vs 17.0%, respectively), although this excess number was not attributable to confirmed RSV infection (PVI, 13.6% vs NPV, 38.9%; P = .14). The hospitalization rate because of RSV infection in the PVI group was 5.5%, which was similar to the NPV group (5%).

Conclusion: In very preterm and extremely low-birth-weight neonates, palivizumab immunoprophylaxis was associated with decreased RSV-positive respiratory events but similar rehospitalization rate as in nonimmunized, moderate, preterm neonates in the first year after hospital discharge.

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