Impact of Respiratory Syncytial Virus Immune Globulin in 1996-1997

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Abstract
Background Immune globulin containing high titers of neutralizing antibodies specific for respiratory syncytial virus (RSV) is clinically used to prevent hospitalizations for RSV-related respiratory infections among high-risk infants. However, recommendations regarding which patient populations should receive RSV immune globulin are inconsistent. Objective To compare hospitalization rates for prematurely born infants with and without chronic lung disease who received RSV immune globulin with similar infants whose parents refused such treatment during the 1996-1997 winter season. Design Inception cohort study. Participants Infants born at less than 35 weeks' gestation and less than 6 months old without lung disease and children who had been born prematurely, had chronic respiratory disease, and were less than 2 years old at the onset of the RSV season. Main Outcome Measure Hospitalization for an RSV-related respiratory illness. Results Seventy-six infants (66 [87%] with chronic lung disease and 10 [13%] born prematurely without lung disease) received RSV immune globulin; 65 infants (18 [28%] with chronic lung disease and 47 [72%] born prematurely without lung disease) did not. Three (4%) of the treated group and 2 (3%) of the untreated group were hospitalized for RSV infections. Of those with chronic lung disease, 5% (3/66) of those treated with RSV immune globulin were hospitalized, compared with 11% (2/18) of those untreated. Of those born prematurely without lung disease, no infant in the treated (0/10) or untreated (0/47) group was hospitalized. Conclusions The risk of hospitalization of infants born prematurely who are younger than 6 months without lung disease is low. Current recommendations for preventing RSV illness in this group by using RSV immune globulin may require inclusion of more specific clinical characteristics rather than gestational age alone.

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