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Objective: To investigate the association between birth weight and respiratory syncytial virus (RSV) hospitalisation during the first year of life in 33°-35 6 weeks' gestational age (wGA) infants., Study Design: Pooled analysis of data (n = 1218) from Spain, Germany, France and Italy., Result: RSV hospitalised infants overall had a significantly higher birth weight than non-hospitalised infants (2.24 versus 2.14 kg; p < 0.001) for both males (2.25 versus 2.18 kg; p = 0.049) and females (2.22 versus 2.11 kg, p = 0.007). The effect was significant only in 34 wGA infants (33 wGA: hospitalised 1.95 kg versus non-hospitalised 1.95 kg, p = 0.976; 34 wGA: 2.26 versus 2.14 kg, p = 0.007; 35 wGA: 2.37 versus 2.29 kg, p = 0.070), particularly female 34 wGA infants (female: 2.24 versus 2.08 kg, p = 0.019; male: 2.27 versus 2.20, p = 0.191). Birth weight was shown to be an independent risk factor for RSV hospitalisation., Conclusions: In 33-35 wGA infants, a higher birth weight appeared independently associated with an increased risk of RSV hospitalisation.

Background: This study aimed at estimating the efficiency of palivizumab in the prevention of Respiratory Syncytial Virus (RSV) infection and its sequelae in preterm infants (32day 1-35day 0weeks of gestational age -wGA-) in Spain.Methods: A decision-tree model was developed to compare health benefits (Quality Adjusted Life Years-QALYs) and costs of palivizumab versus a non-prophylaxis strategy over 6 years. A hypothetical cohort of 1,000 preterm infants, 32day 1-35day 0 wGA (4.356 kg average weight) at the beginning of the prophylaxis (15 mg/kg of palivizumab; 3.88 average number of injections per RSV season) was analysed. The model considered the most recent evidence from Spanish observational and epidemiological studies on RSV infection: the FLIP II study provided hospital admission and Intensive Care Unit (ICU) admission rates; in-hospital mortality rate was drawn from an epidemiological study from 2004 to 2012; recurrent wheezing rates associated to RSV infection from SPRING study were adjusted by the evidence on the palivizumab effect from clinical trials. Quality of life baseline value, number of hospitalized infants and the presence of recurrent wheezing over time were granted to estimate QALYs. National Health Service and societal perspective (included also recurrent wheezing indirect cost) were analysed. Total costs (€, 2016) included pharmaceutical and administration costs, hospitalization costs and recurrent wheezing management annual costs. A discount rate of 3.0% was applied annually for both costs and health outcomes.Results: Over 6 years, the base case analysis showed that palivizumab was associated to an increase of 0.0731 QALYs compared to non-prophylaxis. Total costs were estimated in €2,110.71 (palivizumab) and €671.68 (non-prophylaxis) from the National Health System (NHS) perspective, resulting in an incremental cost utility ratio (ICUR) of €19,697.69/QALYs gained (prophylaxis vs non-prophylaxis). Results derived from the risk-factors population subgroups analysed were in line with the total population results. From the societal perspective, the incremental cost associated to palivizumab decreased to an €1,253.14 (ICUR = €17,153.16€/QALYs gained for palivizumab vs non-prophylaxis). One-way and probabilistic sensitivity analyses confirmed the robustness of the model.Conclusions: The prophylaxis with palivizumab is efficient for preventing from RSV infections in preterm infants 32day 1-35day 0 wGA in Spain. [ABSTRACT FROM AUTHOR]

Premature infants are vulnerable to severe respiratory syncytial virus (RSV) lower respiratory tract infection (LRTI) resulting in hospitalisation and the potential for longer-term respiratory morbidity. Whilst the severity and consequence of RSV LRTI are generally accepted and recognised in infants born ≤32 weeks gestational age (GA), there is less acknowledgment of the potential consequences in infants born 33–35 weeks GA. However, there is a growing body of evidence suggesting that infants born between 33 and 35 weeks GA may be equally at risk for RSV LRTI as infants born <32 weeks GA. Interrupted lung development and an immature immune system have been linked with an increased susceptibility for RSV LRTI, along with other environmental, social, and physiological risk factors. Currently, the only effective method of preventing RSV LRTI is prophylaxis with palivizumab. Often with limited healthcare resources, identifying infants at greatest risk of RSV LRTI who would potentially benefit most from prophylaxis is highly desirable, particularly in the 33–35-week GA group. The purpose of this article is to examine the causes and consequences of RSV LRTI in infants born 33–35 weeks GA, and look at the potential for using risk factors to identify high risk infants and, thereby, optimise prophylaxis. The causes and consequences of RSV LRTI in infants born 33–35 weeks GAA were determined via literature review. A number of underlying risk factors that significantly increase the risk of severe RSV LRTI and subsequent hospitalisation in this group of infants have been identified, most notably from the FLIP and PICNIC studies. A European predictive model based on the risk factors in the FLIP study has recently been developed and validated, which will aid identification of infants born between 33 and 35 weeks GA with the highest risk of RSV hospitalisation. Implementation of this model and prophylaxis of infants born between 33 and 35 weeks GA should be a national or regional decision, taken in perspective of other public health needs. [ABSTRACT FROM AUTHOR]