Variation in clinical practice guidelines for use of palivizumab in
preventing severe respiratory syncytial viral (RSV) disease in high-risk
infants
Abstract
Background: Uniformity and compliance with clinical
practice guidelines (CPGs) for use of palivizumab in preventing severe
RSV infection in Australian high-risk infants remain unclear.
Methods: An online survey was conducted across the
Australian and New Zealand Neonatal Network (ANZNN) to determine
clinical practices around palivizumab. A literature search was also
performed to identify and compare national and international guidelines.
Results: Sixty-five of 422 ANZNN members completed the
survey. Respondents included 61 senior medical staff of
consultants/staff specialists (78%) and four nursing staff (6%).
Infants most likely to be recommended palivizumab included preterm
infants born <29 weeks gestational age (GA) (30%), children
with chronic lung diseases (CLD) born <32 weeks GA (40%), and
with hemodynamically significant heart disease (35%). Many respondents
(53%) stated that CPGs for palivizumab were developed locally. Twenty
guidelines (10 international and 10 domestic) were obtained in total;
16(80%) recommended palivizumab use in preterm infants, 16(80%)
recommended use in infants with CLD, 17(85%) congenital heart disease
(CHD) and six (30%) bronchopulmonary dysplasia (BPD). Eight (40%)
guidelines provided specific recommendations for immunocompromised
infants. Canada, Western Australia, and American Academy of Paediatrics
provided recommendations for Indigenous children. Frequency and dosage
of palivizumab was universal across all CPGs. None of the international
guidelines obtained were from low- or middle-income countries.
Conclusions: Standardisation of CPGs may improve
clinical decision making around use of palivizumab in high-risk infants.