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| |  Additional Risk Factors Plus Current Guidelines Better Predict Severe Disease Among Preterm Infants: Presented at AAP By Martha Kerr, BSN BOSTON -- October 13, 2008 -- Severe respiratory syncytial virus (RSV) in high-risk infants can be better predicted by expanding the current American Academy of Pediatrics (AAP) guidelines to include 3 additional risk factors, according to a study presented at the AAP National Conference & Exhibition. Doris Makari, MD, MedImmune, Gaithersburg, Maryland, and colleagues conducted a study identifying residual risk of severe RSV disease among unprophylaxed preterm infants, which showed that exposure to cigarette smoke, young chronologic age during RSV season, and crowded living conditions are also strong predictors of RSV. The retrospective cohort study included analysis of the medical records of 3,876 infants born at 32 to 35 weeks gestation between April 1, 2005, and November 30, 2006. They reviewed records from 382 practices in 5 geographic areas in the United States. Of the infants included in the study, 1,967 (50.7%) did not receive palivizumab prophylaxis. It was requested, but not authorised, in 528 infants (26.8%). RSV-associated hospitalisations occurred in 44 of the 528 infants (8.3%) for whom prophylaxis was requested and in 42 of 1,429 infants (2.9%) for whom prophylaxis was not requested (P < .01). Diagnosis of RSV-associated hospitalisations required RSV-specific ICD-9 coding or confirmation of RSV in unspecified bronchiolitis or pneumonia. The odds ratio (OR) of severe RSV disease if all 5 AAP criteria are present is 1.42 (95% confidence interval [CI], 0.76-2.65). If smoking is added to current AAP recommendations, the OR would be 1.76 (95% CI, 1.03-2.99); crowded living conditions plus AAP recommendations has an OR of 1.81 (95% CI, 1.04-3.13); and young chronologic age plus AAP recommendations has an OR of 2.19 (95% CI, 1.35-3.58). The 5 current AAP recommendations plus all 3 additional risk factors together have an OR of 2.41 (95% CI, 1.46-3.99). "Following AAP recommendations only would capture only 15% of all premature infants at risk," said Dr. Makari. "Adding all 3 additional risk factors to the current guidelines would capture approximately 45% of cases." "The guidelines are updated every 3 years," Dr. Makari commented in an interview after the presentation. "The AAP committee has seen our data and will consider [them] in their next update, which is due out next year." Funding for this study was provided by an unrestricted grant from MedImmune. [Presentation title: Identifying Residual Risk of Severe RSV Disease Among Unprophylaxed Preterm Infants. Poster 36]
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