0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Original Investigation |

Appropriateness of Age Thresholds for Respiratory Syncytial Virus Immunoprophylaxis in Moderate-Preterm Infants:  A Cohort Study

Almut G. Winterstein, RPh, PhD1,2; Caitlin A. Knox, MPH2; Paul Kubilis, MS2; Christian Hampp, PhD3
[+] Author Affiliations
1Department of Epidemiology, University of Florida, Gainesville
2Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville
3Division of Epidemiology, Office of Pharmacovigilance and Epidemiology, Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, Maryland
JAMA Pediatr. 2013;167(12):1118-1124. doi:10.1001/jamapediatrics.2013.2636.
Text Size: A A A
Published online

Importance  Recommendations concerning the appropriate age threshold for respiratory syncytial virus (RSV) prophylaxis in moderate-preterm infants are highly debated.

Objective  To determine the age at which moderate-preterm infants’ risk of RSV hospitalization has decreased to the risk observed in low-risk term infants.

Design, Setting, and Participants  Retrospective cohort study of Florida and Texas Medicaid fee-for-service billing records matched to birth certificates from Medicaid beneficiaries aged 0 to 12 months with a sibling younger than 5 years and without other indications for RSV prophylaxis between January 1, 1999, and December 31, 2004.

Exposures  For each state, we used discrete time survival analysis to develop age trend models for RSV hospitalizations for 2 groups: moderate-preterm infants (32-34 weeks’ gestational age) and term infants (37-41 weeks’ gestational age).

Main Outcomes and Measures  Age at which preterm infants’ risk of RSV hospitalization equaled the risk for term infants at age 1 month.

Results  Our cohort included 247 566 eligible infants with 5322 RSV hospitalizations. Preterm status doubled the risk for RSV hospitalization in both Florida (odds ratio = 2.41; 95% CI, 1.85-3.12) and Texas (odds ratio = 1.94; 95% CI, 1.64-2.30). Preterm infants’ risk of RSV hospitalization was similar to that for 1-month-old term infants at ages 4.2 months (95% CI, 2.5-5.7) in Florida and 4.5 months (95% CI, 2.8-6.4) in Texas.

Conclusions and Relevance  The age at which moderate-preterm infants showed RSV hospitalization risk similar to their healthy term counterparts supports the more restrictive age thresholds in RSV immunoprophylaxis recommendations. Further studies are warranted to investigate the age-dependent risk of RSV hospitalization in other RSV risk groups.

Figures in this Article

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Place holder to copy figure label and caption
Figure.
Age Effect on Seasonal Respiratory Syncytial Virus Hospitalization Rates in Term and Preterm Infants

Respiratory syncytial virus (RSV) hospitalization rates and 95% CIs averaged across covariates (sex, race, plurality, palivizumab use, season months, and seasons) for infants from Florida (A) and Texas (B) with siblings, estimated from the discrete survival model. The risk level for 1-month-old term infants (horizontal gray reference lines) is shown, and the estimated age (with 95% CI [black horizontal error bars]) at which the risk for moderate-preterm infants has decreased to the risk level for 1-month-old term infants is indicated (vertical reference lines) (ages 4.2 months in Florida [A] and 4.5 months in Texas [B]).

Graphic Jump Location

Tables

References

Correspondence

CME
Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 6

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
Jobs
brightcove.createExperiences();