Respiratory syncytial virus hospitalizations in US preterm infants after the 2014 change in immunoprophylaxis guidance by the American Academy of Pediatrics

Palivizumab is the only licensed and effective immunoprophylaxis (IP) available to prevent respiratory syncytial virus (RSV) infection in high-risk infants including infants born at <= 35 weeks' gestational age (wGA). In 2014, the American Academy of Pediatrics stopped recommending IP for otherwise healthy 29-34 wGA infants, stating that their risk of RSV hospitalization (RSVH) was similar to term infants. Recent studies have demonstrated a significant decline in IP use after 2014 that was accompanied by an increased risk of RSVH in 29-34 wGA infants vs term infants. Severity and healthcare utilization of RSVH were high among 29-34 wGA infants. In 2018, the National Perinatal Association developed guidelines advocating IP use in all <= 32 wGA infants and 32-35 wGA infants with additional risk factors. Risk factor predictive models can identify infants who are at risk for RSVH and promote cost-effective use of palivizumab until new methods of RSV prevention become available.