99 Respiratory Syncytial Virus (RSV) Prophylaxis for Infants Discharged from Tertiary Care Settings: Compliance and Outcomes

RSV prophylaxis with palivizumab is initiated in some tertiary care centres prior to discharge. In the 1999–2000 RSV season, an audit at one of three affiliated Canadian centres revealed that after babies were discharged, up to 30% of parents were not aware of prophylaxis being continued. In order to facilitate compliance, an enhanced educational program was implemented and an evaluative study conducted.

1) To assess the compliance with RSV prophylaxis after infants have been discharged from hospital; 2) To assess outcomes due to RSV-related admissions and potential adverse events temporally associated with palivizumab prophylaxis.

The study targeted infants whose RSV prophylaxis was started at 3 affiliated tertiary care centres during the RSV season from 11/2000 to 3/2001. Prophylaxis was based on Canadian guidelines and was accompanied by an educational program for health care providers and parents. Telephone survey data were supplemented by reviews of the Hospital Medical records, as indicated.

Data were obtained on 292 subjects, representing 71.4% of those eligible for prophylaxis. Mean gestational age 29.0 wks (SD±2.66); mean birth weight 1293 grams (SD±457); male:female ratio 1.2:1. RSV prophylaxis was continued in the community in 81.7% of subjects, no pro-phylaxis given in 10.6% and the prophylaxis status undetermined in 7.7%. Symptoms of respiratory viral infections (RVI) resulting in medical visits occurred in 16.1% (47/292). 7.9% (23/292) had at least 1 admission, with the reason being RVI in 4.8% (14/292). There was 1 proven RSV-related admission (0.34%). The frequency of potential adverse events regardless of causation were: fever 2.7%, rash 2.1%, vomiting 1.4%, irritability <1%, and injection site reactions <1%.

Following initiation of prophylaxis accompanied by an enhanced educational package, compliance with continued RSV prophylaxis was high. The low rates of admissions related to RSV and potential adverse events are consistent with favorable safety and effectiveness profiles of palivizumab.