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Administer palivizumab1 during 1st yr of life when <12 mo old at start of RSV season [B/S] Other preventive measures: - Disinfect hands before/after direct contact w/ pts, after contact w/ objects near pt, before/after removing gloves [B/S]
- Use alcohol-based rubs for hand decontamination when caring for bronchiolitis pts; if not available, wash hands w/ soap and water [B/S]
- Inquire about pt exposure to tobacco smoke [C/M]
- Counsel caregivers about tobacco smoke exposure/smoking cessation [B/S]
- Encourage exclusive breastfeeding for at least 6 mo [B/M]
- Educate personnel/family members on dx, tx, and prevention of bronchiolitis [C/M]
Footnotes 1 Administer palivizumab 15 mg/kg IM monthly x5 mo max, or until end of RSV season, whichever comes first [B/M]. If breakthrough RSV infxn occurs, discontinue palivizumab prophylaxis.
With CHD/CLDP/impaired airway clearance/immunocompromise Congenital heart dz (CHD): - If hemodynamically significant CHD,2,3 administer palivizumab4 during 1st yr of life, when <12 mo old at start of RSV season [B/S]
- Children <2 yo who undergo cardiac transplantation during RSV season may be considered for palivizumab prophylaxis
Chronic lung dz of prematurity (CLDP):5 - Administer palivizumab4 during 1st yr of life [B/M]; consider another season of palivizumab prophylaxis in the 2nd yr of life if pt continues to require medical support6
Cystic fibrosis: - Palivizumab prophylaxis not routinely recommended; may consider4 if <12 mo old and w/ CLD and/or nutritional compromise, or in 2nd yr of life if manifestations of severe lung dz7 or weight for length <10th percentile
Neuromuscular disease or pulmonary abnormality: - Palivizumab prophylaxis not routinely recommended; may consider4 if <12 mo old w/ impaired ability to clear lower airway secretions
Down syndrome: - Palivizumab prophylaxis not routinely recommended unless coexisting CHD/CLDP4
Immunocompromised: - Palivizumab prophylaxis not routinely recommended; may consider4 for children <24 mo of age who are profoundly immunocompromised (eg, stem cell transplant pts) during RSV season
Other preventive measures: - Disinfect hands before/after direct contact w/ pts, after contact w/ objects near pt, before/after removing gloves [B/S]
- Use alcohol-based rubs for hand decontamination when caring for bronchiolitis pts; if not available, wash hands w/ soap and water [B/S]
- Inquire about pt exposure to tobacco smoke [C/M]
- Counsel caregivers about tobacco smoke exposure/smoking cessation [B/S]
- Encourage exclusive breastfeeding for at least 6 mo [B/M]
- Educate personnel/family members on dx, tx, and prevention of bronchiolitis [C/M]
Footnotes 2 Children most likely to benefit from immunoprophylaxis include: 1) infants w/ acyanotic heart dz on medication to control CHF and who will require cardiac surgical procedures; and 2) infants w/ mod to severe pulmonary HTN. Consult a pediatric cardiologist for decisions regarding prophylaxis for infants w/ cyanotic heart defects in the 1st yr of life.
3 The following groups of infants w/ CHD are not at increased risk of RSV infxn and generally should not receive immunoprophylaxis: 1) infants /children w/ hemodynamically insignificant heart dz (eg, secundum ASD, small VSD, pulmonic stenosis, mild coarctation of aorta, and PDA, 2) infants w/ lesions adequately corrected by surgery, unless medication for CHF still required, 3) infants w/ mild cardiomyopathy not on medical tx for the condition, and 4) children in the 2nd yr of life.
4 Administer palivizumab 15 mg/kg IM monthly x5 mo max, or until end of RSV season, whichever comes first [B/M]. If breakthrough RSV infxn occurs, discontinue palivizumab prophylaxis.
5 CLDP definition: <32 wks gestation requiring >21% O2 for at least the first 28 days of life.
6 If continuing to require supplemental O2, diuretic tx, or chronic steroids w/in 6 mo of start of RSV season.
7 If previous hospitalization for pulmonary exacerbation in the 1st yr of life, or abnormalities on chest radiography or chest CT that persist when stable.
Without CHD/CLDP/impaired airway clearance/immunocompromise Palivizumab prophylaxis not indicated [B/S] Other preventive measures: - Disinfect hands before/after direct contact w/ pts, after contact w/ objects near pt, before/after removing gloves [B/S]
- Use alcohol-based rubs for hand decontamination when caring for bronchiolitis pts; if not available, wash hands w/ soap and water [B/S]
- Inquire about pt exposure to tobacco smoke [C/M]
- Counsel caregivers about tobacco smoke exposure/smoking cessation [B/S]
- Encourage exclusive breastfeeding for at least 6 mo [B/M]
- Educate personnel/family members on dx, tx, and prevention of bronchiolitis [C/M]
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With CHD/impaired airway clearance/immunocompromise Congenital heart dz (CHD): - If hemodynamically significant CHD,8,9 administer palivizumab10 during 1st yr of life, when <12 mo old at start of RSV season [B/S]
- Children <2 yo who undergo cardiac transplantation during RSV season may be considered for palivizumab prophylaxis
Cystic fibrosis: - Palivizumab prophylaxis not routinely recommended; may consider10 if <12 mo old and w/ CLD and/or nutritional compromise, or in 2nd yr of life if manifestations of severe lung dz11 or weight for length <10th percentile
Neuromuscular disease or pulmonary abnormality: - Palivizumab prophylaxis not routinely recommended; may consider10 if <12 mo old w/ impaired ability to clear lower airway secretions
Down syndrome: - Palivizumab prophylaxis not routinely recommended unless coexisting CHD10
Immunocompromised: - Palivizumab prophylaxis not routinely recommended; may consider10 for children <24 mo of age who are profoundly immunocompromised (eg, stem cell transplant pts) during RSV season
Other preventive measures: - Disinfect hands before/after direct contact w/ pts, after contact w/ objects near pt, before/after removing gloves [B/S]
- Use alcohol-based rubs for hand decontamination when caring for bronchiolitis pts; if not available, wash hands w/ soap and water [B/S]
- Inquire about pt exposure to tobacco smoke [C/M]
- Counsel caregivers about tobacco smoke exposure/smoking cessation [B/S]
- Encourage exclusive breastfeeding for at least 6 mo [B/M]
- Educate personnel/family members on dx, tx, and prevention of bronchiolitis [C/M]
Footnotes 8 Children most likely to benefit from immunoprophylaxis include: 1) infants w/ acyanotic heart dz on medication to control CHF and who will require cardiac surgical procedures; and 2) infants w/ mod to severe pulmonary HTN. Consult a pediatric cardiologist for decisions regarding prophylaxis for infants w/ cyanotic heart defects in the 1st yr of life.
9 The following groups of infants w/ CHD are not at increased risk of RSV infxn and generally should not receive immunoprophylaxis: 1) infants /children w/ hemodynamically insignificant heart dz (eg, secundum ASD, small VSD, pulmonic stenosis, mild coarctation of aorta, and PDA, 2) infants w/ lesions adequately corrected by surgery, unless medication for CHF still required, 3) infants w/ mild cardiomyopathy not on medical tx for the condition, and 4) children in the 2nd yr of life.
10 Administer palivizumab 15 mg/kg IM monthly x5 mo max, or until end of RSV season, whichever comes first [B/M]. If breakthrough RSV infxn occurs, discontinue monthly palivizumab prophylaxis.
11 If previous hospitalization for pulmonary exacerbation in the 1st yr of life, or abnormalities on chest radiography or chest CT that persist when stable.
Without CHD/impaired airway clearance/immunocompromise Palivizumab prophylaxis not indicated [B/S] Other preventive measures: - Disinfect hands before/after direct contact w/ pts, after contact w/ objects near pt, before/after removing gloves [B/S]
- Use alcohol-based rubs for hand decontamination when caring for bronchiolitis pts; if not available, wash hands w/ soap and water [B/S]
- Inquire about pt exposure to tobacco smoke [C/M]
- Counsel caregivers about tobacco smoke exposure/smoking cessation [B/S]
- Encourage exclusive breastfeeding for at least 6 mo [B/M]
- Educate personnel/family members on dx, tx, and prevention of bronchiolitis [C/M]
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