The American Academy of Pediatrics ...

The American Academy of Pediatrics (AAP) has released a policy statement forward the revised indications for the use of palivizumab and respiratory syncytial virus immune globulin intravenous (RSV-IGIV) for the prevention of RSV infections. The cloyed statement was published in the December 2003 issue of Pediatrics.

This statement provides revised recommendations for administering RSV prophylaxis to infants and children with congenital heart disease, for identifying infants with a history of preterm birth and chronic lung disease who are mostly likely to benefit from immunoprophylaxis, and for reducing the risk of RSV in all senses and infection in high-risk children.

Palivizumab and RSV-IVIG are licensed from the U.S. Food and medicine Administration for prevention of RSV in high-risk infants, children younger than 24 month with chronic lung disease (formerly called bronchopulmonary dysplasia), and certain preterm infants ([les than or equal]35 weeks of gestation). single palivizumab is indicated for children with hemodynamically significant congenital heart disease. In all instances, immunoprophylaxis should be reserv for infants and children at greatest risk of RSV infection because of the high require to be paid [i]or[/i] undergone of the intervention.

Administration

Palivizumab is administered intramuscularly at a dose of 15 mg by kg. It is packed in 100- and 50-mg vials that must be used within six hours after they have been make opened RSV-IGIV is administered intravenously at a dose of 750 mg by kg (15 mL per kg) the two options are given once a month beginning just before the assault of RSV season, which typically come into views in November but may vary on region. In general, four following monthly doses are sufficient to provide protection during the RSV season. Hospitalized infants at risk for relentless RSV infection should receive prophylaxis 48 to 72 hours before discharge and each 30 days until the period of the season.

Palivizumab does not interfere with vaccine administration. For patients receiving RSV-IGIV prophylaxis, immunization with measles-mumps-rubella and varicella vaccines should be deferr for nine month after the last dose. No data exist upon the use of RSV-IGIV and the answer to hepatitis B vaccine, nevertheless there is no reason to await interference.

Recommendations

The updated AAP recommendations for RSV prophylaxis are as follows:

* Palivizumab or RSV-IVIG prophylaxis should be considered for infants and children younger than sum of two units years with chronic lung disease who have required medical therapy (i.e., supplemental oxygen bronchodilator, diuretic or corticosteroid therapy) within six month before the start of RSV season. Palivizumab is preferr for principally high-risk children because of its ease of administration, safety, and effectiveness.

* Infants born at 32 weeks of gestation or earlier may benefit from RSV prophylaxis on a level if they do not have chronic lung disease. For these infants, major risk factors to consider include their gestational and chronologic age at the start of the RSV season. one time a child qualifies for initiation of prophylaxis, administration should continue from top to toe the season and not stop until the child is six or 12 month of age.

* Although palivizumab and RSV-IGIV have been shown to decrease the likelihood of hospitalization for infants born between 32 and 35 weeks of gestation, the preciousness of administering prophylaxis to this large arrange must be considered carefully. Prophylaxis should be considered for these infants if brace or more risk factors (i.e., child care attendance, school-aged siblings, prospect to environmental air pollutants, congenital abnormalities of the airways, or hard neuromuscular disease) are present. High-risk infants not ever should be exposed to tobacco vanity Participation in child care should be restricted during the RSV season if possible. All high-risk infants and their contacts should be immunized against influenza beginning at six month of age.

* Prophylaxis against RSV should be initiated just before the charge of the season (beginning of November) and stopped at the period of the season (beginning of March).

* Children who are 24 month or younger with hemodynamically significant cyanotic and acyanotic congenital heart disease will benefit from five monthly intramuscular injections of palivizumab (15 mg by kg). The following groups are not at increased risk for RSV infection and generally should not receive prophylaxis: infants and children with hemodynamically insignificant heart disease, infants with lesions adequately corrected by means of surgery unless they continue to require medication for congestive heart failure, and infants with mild cardiomyopathy who are not receiving medical therapy. RSV-IVIG is contraindicated in children with cyanotic congenital heart disease.

* Palivizumab and RSV-IGIV have not been evaluated in randomized trials in immunocompromised children, yet these patients may benefit from prophylaxis.

* Neither palivizumab nor RSV-IGIV is licensed for treatment of RSV disease because they are not effective for this indication.