Why Preemies are at an Increased Risk for RSV

Need to know information about your preemie and RSV

Why is RSV it so dangerous for premature babies?

In babies born prematurely at 35 weeks or less gestation, the lungs and respiratory system are not yet fully developed. This means that a Respiratory (RSV) infection can be much more serious to a premature baby, causing clogging of the airways and serious difficulty with breathing. Many times, the infection in preemies is serious enough to require a hospital stay.

What are the consequences of RSV?

RSV is the number one reason that infants in the United States under one year of age are admitted to the hospital. Premature babies are twice as likely to require hospitalization from an RSV infection than full-term infants and hospital stays are typically twice as long for preemies. RSV can also lead to bronchiolitis and pneumonia in premature babies.

What are some preemie RSV facts I need to know?

Respiratory Syncytial Virus (RSV) is a common, easily spread virus that almost all children catch at least once by the time they turn two. It usually causes mild to moderate cold symptoms. But for premature babies, babies who have chronic lung disease, or those who were born with certain heart problems, RSV can lead to serious health problems.

  • Preemie lung volume (before approximately 36 weeks gestation) is only about half  (52%) of the lung volume seen in full-term infants.
  • A preemie's airways are smaller and narrower than a full-term baby's airways.
  • RSV infection of the small airways of the lung is the leading cause of hospitalization among infants in the United States.

  • For babies born early, RSV can lead to serious lung infections such as pneumonia and Bronchiolitis.

Even as your premature infant starts to look healthy and strong, babies born early are at high risk for severe RSV disease, in part due to underdeveloped lungs.

What do I need to know about RSV based on my preemie's gestational age?

  • If your baby was born at or before 28 weeks gestation your baby may not have received all the virus-fighting substances, called antibodies from mom. Babies born at or before 28 weeks gestation have small, underdeveloped, and narrow airways. This puts them at high risk for a severe case of RSV if they should come in contact with the virus.
  • If your baby was born between 29 and 31 weeks gestation your baby is still at a greater risk of serious breathing problems and potential hospitalization from RSV. RSV can cause your baby's narrow and premature lungs to become clogged making it very difficult to breathe. Special precautions should be taken to help minimize the potential exposure to the virus during RSV season.
  • If your baby was born between 32 and 35 weeks gestation your baby still is a risk for developing an RSV infection that may lead to a serious lung infection. Your baby's lungs are still premature with developing airways that are narrow and especially fragile.
  • If your baby was born between 36 weeks gestation and term you need to remember that your baby is still premature and is at greater risk of serious complications from RSV. Knowing the risks and being proactive in prevention will help to keep your preemie safe during RSV season.

Is there anything that can help prevent an RSV infection in my baby?

Synagis (palivizumab) what is it?

Synagis is a prescription medication that is used to help prevent a serious lung disease
caused by the respiratory syncytial virus (RSV) in children at high risk for severe lung disease
from RSV.

  • Synagis  can help protect your high-risk baby from severe RSV disease.
  • Synagis is not a vaccine. It’s an FDA-approved shot of antibodies that is given
    monthly to help protect high-risk children from severe RSV disease.

What are antibodies?

Antibodies are proteins that your body makes to fight infection. They are a very important part of the immune system. During pregnancy, antibodies are passed from mother to baby. These are called maternally transmitted antibodies.

In the months after birth, the amount of these antibodies gets lower. With fewer antibodies to protect them, it is harder for some infants to fight off serious infections.

Synagis contains virus-fighting antibodies that attach to a specific protein found on the surface of RSV. This can help protect your high-risk baby from severe RSV disease.

Each dose provides enough antibodies to protect your baby for about a month.

High-risk babies may not have enough antibodies to fight off an RSV infection. Regular monthly dosing with Synagis can help.

If your high-risk baby was born during RSV season, he or she may have received the first dose of Synagis in the NICU.  During RSV season, babies who are at high risk should continue to get a Synagis shot every 28 to 30 days.

New Guidelines For Synagis Administration

(November 1, 2014 thru March 31, 2015)

On July 28, 2014, The American Academy of Pediatrics (AAP) released new guidelines and recommendations that could affect the way severe lower respiratory tract disease from respiratory syncytial virus (RSV) is prevented. RSV is the most common cause of bronchiolitis and pneumonia in children younger than 1 year of age in the United States.

The new guidance by the American Academy of Pediatrics on Synagis state:

During the first year of life

Synagis is recommended during RSV season for the following infants:

  • Preterm infants born at or before 29 weeks gestation who are younger than 12 months of age.
  • Preterm infants with chronic lung disease (CLD) born at or before 32 weeks gestation who required 21 percent oxygen therapy for at least 28 days after birth.
  • Infants with hemodynamically significant congenital heart disease. (Infants who are receiving medication to control congestive heart failure and will require cardiac surgical procedures. Infants with moderate to severe pulmonary hypertension. Children younger than 2 years who undergo cardiac transplant during the RSV season.)
  • Children with anatomic abnormalities or neuromuscular disorders. (infants with impaired ability to clear secretions from the upper airway during the first year of life.)
  • Maximum 5 monthly doses may be provided during the RSV season.
    (November 1, 2014 thru March 31, 2015)

During the second year of life

A second season of Synagis is now only recommended for preterm infants with CLD of prematurity who satisfied the above criteria and continue to receive medical therapy (chronic corticosteroid therapy, diuretic therapy or supplemental oxygen) during the 6 month period before the start of the second RSV season.

You can learn more about these new guidelines.

I​f your baby does not qualify under the new criteria or you have been denied coverage by your insurance company, you may be able to appeal.

RSV is typically tolerated by healthy individuals much like the common cold. However, for those at high risk, the consequences of the illness can be severe. Taking preventative measures goes a long way towards keeping your premature baby healthy during the winter months when the virus is most prevalent. Talk to your health care provider about your baby's specific risk for RSV and ways you can work together to prevent and be proactive in protecting your baby during RSV season.

References

AstraZeneca Battles Pediatrician Group Over Preemie Drug Guidelines - Pharmalot - WSJ. (n.d.). Retrieved from http://blogs.wsj.com/pharmalot/2014/07/28/astrazeneca-battles-pediatrician-group-over-preemie-drug-guidelines/

Know what you're up against with RSV. (n.d.). Retrieved from http://rsvprotection.com

Synagis (palivizumab) injections for respiratory syncytial virus (RSV) prophylaxis. (n.d.). Retrieved from https://www.healthpartners.com/public/coverage-criteria/synagis-injections/

Synagis® (palivizumab). (n.d.). Retrieved from http://synagis.com

Updated Guidance for Palivizumab Prophylaxis Among Infants and Young Children at Increased Risk of Hospitalization for Respiratory Syncytial Virus Infection. (n.d.). Retrieved from http://pediatrics.aappublications.org/content/134/2/415.full.html

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