Chadha Ashley D, Bao Weichao, Holloway Jeff, Mann Joshua, Rye Anna K, Brown David E
Palmetto Health University of South Carolina, University of South Carolina Arnold School of Public Health, USA.
South Med J. 2012 Aug;105(8):399-404. doi: 10.1097/SMJ.0b013e31825ea57d.
Respiratory syncytial virus (RSV) has been identified as an important cause of lower respiratory tract disease in infants. In patients at high risk, prevention is attempted through immunoprophylaxis with palivizumab. In 2008, as a result of revisions to the American Academy of Pediatrics' guidelines, South Carolina Medicaid reduced the number of approved palivizumab doses from six to five. This study attempted to determine whether the reduction of approved doses would affect hospitalization and emergency department visits and to characterize dose administration.
We obtained data for all South Carolina Medicaid reimbursed births from November 2004 through March 2009. For each RSV season, infants who should have received palivizumab were identified. Rates of outpatient palivizumab dosing and hospitalizations and emergency department visits because of RSV also were identified.
In the seasons sampled, 1956 infants met eligibility criteria for our study. Infants younger than 29 weeks' gestation received 34% to 48% of their total eligible palivizumab doses, whereas infants 29 to 31 weeks' gestation received 36% to 46% of their doses. The rate of emergency department visits and inpatient admissions because of RSV did not differ significantly across years.
In evaluating our primary outcome, there was no increase in hospitalizations or emergency department visits. Overall, we did note a poor dosing rate in all of the groups. A statistically significant decline in dosing per eligible month was noted following the dose reductions. Despite solid evidence of the benefits of palivizumab in high-risk groups, we are doing an inadequate job of dosing these patients.
We believe adherence to current recommendations for palivizumab dosing is suboptimal in preterm infants insured by the South Carolina Medicaid program. Healthcare professionals must work harder to identify and follow-up with patients who qualify for palivizumab dosing, including infants who meet criteria for a second season.
呼吸道合胞病毒（RSV）已被确认为婴儿下呼吸道疾病的重要病因。对于高危患者，尝试通过使用帕利珠单抗进行免疫预防。2008年，由于美国儿科学会指南的修订，南卡罗来纳州医疗补助计划将批准的帕利珠单抗剂量从六剂减至五剂。本研究试图确定批准剂量的减少是否会影响住院率和急诊就诊率，并对剂量给药情况进行描述。
我们获取了2004年11月至2009年3月所有南卡罗来纳州医疗补助计划报销的出生数据。对于每个RSV季节，确定应接受帕利珠单抗治疗的婴儿。还确定了门诊帕利珠单抗给药率以及因RSV导致的住院率和急诊就诊率。
在抽样的季节中，1956名婴儿符合我们的研究资格标准。孕周小于29周的婴儿接受了其总合格帕利珠单抗剂量的34%至48%，而孕周为29至31周的婴儿接受了其剂量的36%至46%。因RSV导致的急诊就诊率和住院率在各年份之间没有显著差异。
在评估我们的主要结局时，住院率和急诊就诊率没有增加。总体而言，我们确实注意到所有组的给药率都很低。剂量减少后，每个合格月份的给药量出现了统计学上的显著下降。尽管有确凿证据表明帕利珠单抗在高危人群中有益，但我们在给这些患者给药方面做得不够。
我们认为，在南卡罗来纳州医疗补助计划承保的早产儿中，对帕利珠单抗给药的现行建议的依从性欠佳。医疗保健专业人员必须更加努力地识别符合帕利珠单抗给药条件的患者并进行随访，包括符合第二个季节标准的婴儿。
