National Evidence in Israel Supporting Reevaluation of Respiratory Syncytial Virus Prophylactic Guidelines

Background: The American Academy of Pediatrics (AAP) recently narrowed the indications for respiratory syncytial virus (RSV) prophylaxis, while in Israel the guidelines have not changed. Objective: To compare the prevalence and severity of RSV infection among preterm infants born earlier than 34⁰/₇ weeks of gestation (PI), late preterm infants born at 34⁰/₇-36⁶/₇ weeks (LPTI), and term infants born after 37⁰/₇ weeks of gestation (TI) and to determine whether the results support a change in local policy. Methods: Data of all children aged 0-14 years hospitalized with PCR-positive RSV in a single tertiary center from 2010 to 2014 were collected. A total of 793 children were included and divided into 3 groups: 637 were TI, 105 were LPTI, and 50 were PI. These groups were compared regarding incidence of hospitalization due to RSV infection, intensive care unit (ICU) hospitalization, and length of hospitalization. Results: The hospitalization rate due to RSV infection was 5.2, 3.5, and 1.3% among PI, LPTI, and TI, respectively (p < 0.01). The hospitalization rate in the ICU was 24, 7.6, and 3% among PI, LPTI, and TI, respectively (p < 0.001). The length (days) of hospitalization was significantly longer among PI compared with LPTI and TI (p < 0.001). Overall, the hospitalization rate and disease severity were significantly higher for infants born earlier than 35 weeks of gestation compared with more maturely born infants. Conclusion: RSV infection remains a major cause of morbidity among children born prematurely even after RSV prophylaxis and would probably be greater were prophylaxis curtailed. Our results do not support applying the current AAP guidelines in Israel. Further local studies are needed to optimize prophylaxis for both PI and LPTI.