Mondì Vito, Paolillo Piermichele, Bedetta Manuela, Lucangeli Natalia, Picone Simonetta
Neonatology and Neonatal Intensive Care Unit, Policlinico Casilino Hospital, Rome, Italy.
Front Pediatr. 2023 Jun 8;11:1154518. doi: 10.3389/fped.2023.1154518. eCollection 2023.
Preterm infants born between 33 and 35 weeks of gestational age (wGA) have been considered a "major underserved population" and ineligible to receive palivizumab (PLV), the only drug authorized to date for respiratory syncytial virus (RSV) prophylaxis, by current international guidelines. In Italy, such a vulnerable population is currently eligible for prophylaxis, and, in our region, specific risk factors are taken into consideration (SIN score) to target prophylaxis for those at highest risk. Whether the adoption of less or more restrictive eligibility criteria for PLV prophylaxis would translate into differences in bronchiolitis and hospitalization incidence is not known.
A retrospective analysis was conducted in 296 moderate-to-late preterm infants (born between 33 and 35 weeks) who were being considered for prophylaxis in two epidemic seasons: 2018-2019 and 2019-2020. The study participants were categorized according to both the SIN score and the Blanken risk scoring tool (BRST), which was found to reliably predict RSV-associated hospitalization in preterm infants on the basis of three risk factor variables.
Based on the SIN score, approximately 40% of infants (123/296) would meet the criteria to be eligible for PLV prophylaxis. In contrast, none of the analyzed infants would be considered eligible for RSV prophylaxis on the basis of the BRST. A total of 45 (15.2%) bronchiolitis diagnoses were recorded on average at 5 months of age in the overall population. Almost seven out of 10 (84/123) patients exhibiting ≥3 risk factors to be eligible for RSV prophylaxis according to SIN criteria would not be receiving PLV if they were categorized on the basis of the BRST. Bronchiolitis occurrence in patients with a SIN score ≥3 was approximately 2.2 times more likely than that in patients with a SIN score <3. PLV prophylaxis has been associated with a 91% lower risk of requiring a nasal cannula.
Our work further supports the need for targeting late preterm infants for RSV prophylaxis and calls for an appraisal of the current eligibility criteria for PLV treatment. Therefore, adopting less restrictive criteria may ensure a comprehensive prophylaxis of the eligible subjects, thus sparing them from avoidable short- and long-term consequences of RSV infection.
孕周在33至35周之间出生的早产儿被视为“主要未得到充分服务的人群”，根据当前国际指南，他们没有资格接受帕利珠单抗（PLV）治疗，PLV是迄今为止唯一被批准用于预防呼吸道合胞病毒（RSV）的药物。在意大利，这类弱势群体目前有资格接受预防治疗，在我们地区，会考虑特定的风险因素（SIN评分）来针对高危人群进行预防。对于PLV预防采用更宽松或更严格的资格标准是否会导致细支气管炎和住院发生率的差异尚不清楚。
对296例中度至晚期早产儿（孕周在33至35周之间）进行了回顾性分析，这些早产儿在2018 - 2019年和2019 - 2020年两个流行季节被考虑进行预防治疗。研究参与者根据SIN评分和布兰肯风险评分工具（BRST）进行分类，BRST基于三个风险因素变量被发现能够可靠地预测早产儿RSV相关住院情况。
根据SIN评分，约40%的婴儿（123/296）符合接受PLV预防的标准。相比之下，根据BRST，分析的婴儿中没有一个会被认为有资格接受RSV预防。总体人群中，平均在5个月大时共记录到45例（15.2%）细支气管炎诊断病例。根据SIN标准有≥3个风险因素而有资格接受RSV预防的患者中，几乎十分之七（84/123）如果根据BRST分类将不会接受PLV治疗。SIN评分≥3的患者发生细支气管炎的可能性比SIN评分<3的患者高约2.2倍。PLV预防与需要鼻导管的风险降低91%相关。
我们的工作进一步支持了针对晚期早产儿进行RSV预防的必要性，并呼吁对PLV治疗的当前资格标准进行评估。因此，采用限制较少的标准可能确保对符合条件的受试者进行全面预防，从而使他们免受RSV感染可避免的短期和长期后果。
