A preterm infant born at 31 weeks’ gestation, now 4 months old, with no major complications other than a minor intraventricular hemorrhage at birth. If the local RSV season is approaching, what RSV prophylaxis schedule should the PNP consider today?

A preterm infant born at 31 weeks’ gestation, now 4 months old, with no major complications other than a minor intraventricular hemorrhage at birth. If the local RSV season is approaching, what RSV prophylaxis schedule should the PNP consider today?

• A. RSV prophylaxis in six monthly doses, if the local RSV season is approaching
• B. Nothing, because the infant did not have bronchopulmonary dysplasia at birth
• C. Nothing, if the RSV season has already begun
• D. RSV prophylaxis in three monthly doses if the local RSV season is approaching

Answer: (A)

RSV prophylaxis with palivizumab is given to high-risk infants during RSV season to provide passive protection, since a vaccine isn’t available for this purpose. The antibody is given as monthly injections, and the goal is to cover the duration of the RSV season with several doses so the infant remains protected during the peak risk period. In this case, a preterm infant born at 31 weeks who is now about four months old remains at high risk for severe RSV disease. When the local RSV season is approaching, starting palivizumab now and continuing with monthly doses through the season is the appropriate plan. Providing about six monthly doses helps ensure protection across the entire period of RSV activity, especially since the infant will still be under one year old during the season. Waiting to start prophylaxis or giving only a few doses would leave the infant vulnerable during the peak months. The absence of bronchopulmonary dysplasia does not negate the indication for prophylaxis in this very preterm infant, and if the season has already begun, eligible infants should still receive prophylaxis rather than nothing.

RSV prophylaxis with palivizumab is given to high-risk infants during RSV season to provide passive protection, since a vaccine isn’t available for this purpose. The antibody is given as monthly injections, and the goal is to cover the duration of the RSV season with several doses so the infant remains protected during the peak risk period.

In this case, a preterm infant born at 31 weeks who is now about four months old remains at high risk for severe RSV disease. When the local RSV season is approaching, starting palivizumab now and continuing with monthly doses through the season is the appropriate plan. Providing about six monthly doses helps ensure protection across the entire period of RSV activity, especially since the infant will still be under one year old during the season.

Waiting to start prophylaxis or giving only a few doses would leave the infant vulnerable during the peak months. The absence of bronchopulmonary dysplasia does not negate the indication for prophylaxis in this very preterm infant, and if the season has already begun, eligible infants should still receive prophylaxis rather than nothing.