Detail (Long)
<b>Palivizumab-eligible children 8-19 mo:</b> Suspend use of nirsevimab for the 2023-2024 RSV season and give <a href=https://online.epocrates.com/e/deeplink/drugs/10a2278/Synagis><u><b>palivizumab (Synagis)</b></u></a>.<sup>1,2</sup><br>
◦ <b>Palivizumab ppx is recommended for:</b> infants in the 1st year of life born before 29 wk gestation; preterm infants in the 1st year of life w/ chronic lung dz of prematurity (birth at <32 wk gestation and requiring >21% O<sub>2</sub> for ≥28 days after birth); certain infants in the 1st year of life w/ hemodynamically significant heart dz; children in the 1st year of life w/ pulmonary abnormality or neuromuscular dz that impairs the ability to clear secretions from the upper airways; children <24 mo who will be profoundly immunocompromised during the RSV season.<br>
◦ Palivizumab ppx is <b>not recommended</b> for: otherwise healthy infants born at or after 29 wk gestation; prevention of health care–associated RSV dz; children in the 2nd year of life except those who required ≥28 days of supplemental O<sub>2</sub> after birth and still require supplemental O<sub>2</sub>, chronic corticosteroid, or diuretic tx.<br>
◦ <b>Insufficient data:</b> children w/ cystic fibrosis, Down syndrome.<br>
◦ <b>Dosing.</b> Clinicians may administer up to 5 monthly doses of palivizumab (15 mg/kg per dose) during the RSV season to qualifying infants in the 1st year of life. Infants born during the RSV season may require fewer doses—e.g., those born in Jan. would receive their last dose in Mar.<br>
◦ <b>D/c monthly ppx in any child who experiences a breakthrough RSV hospitalization.</b><br>
◦ <b>Alaska Native and possibly selected other American Indian populations:</b> RSV dz burden and costs associated w/ transport from remote locations may result in broader use of palivizumab for RSV prevention.
◦ <b>Palivizumab ppx is recommended for:</b> infants in the 1st year of life born before 29 wk gestation; preterm infants in the 1st year of life w/ chronic lung dz of prematurity (birth at <32 wk gestation and requiring >21% O<sub>2</sub> for ≥28 days after birth); certain infants in the 1st year of life w/ hemodynamically significant heart dz; children in the 1st year of life w/ pulmonary abnormality or neuromuscular dz that impairs the ability to clear secretions from the upper airways; children <24 mo who will be profoundly immunocompromised during the RSV season.<br>
◦ Palivizumab ppx is <b>not recommended</b> for: otherwise healthy infants born at or after 29 wk gestation; prevention of health care–associated RSV dz; children in the 2nd year of life except those who required ≥28 days of supplemental O<sub>2</sub> after birth and still require supplemental O<sub>2</sub>, chronic corticosteroid, or diuretic tx.<br>
◦ <b>Insufficient data:</b> children w/ cystic fibrosis, Down syndrome.<br>
◦ <b>Dosing.</b> Clinicians may administer up to 5 monthly doses of palivizumab (15 mg/kg per dose) during the RSV season to qualifying infants in the 1st year of life. Infants born during the RSV season may require fewer doses—e.g., those born in Jan. would receive their last dose in Mar.<br>
◦ <b>D/c monthly ppx in any child who experiences a breakthrough RSV hospitalization.</b><br>
◦ <b>Alaska Native and possibly selected other American Indian populations:</b> RSV dz burden and costs associated w/ transport from remote locations may result in broader use of palivizumab for RSV prevention.