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Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health

American Academy of Pediatrics
Article

Use of Palivizumab in Primary Practice

Keith M. Perrin and Rodolfo E. Bégué
Pediatrics January 2012, 129 (1) 55-61; DOI: https://doi.org/10.1542/peds.2010-2991
Keith M. Perrin
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Rodolfo E. Bégué
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Abstract

Objective: To describe the implementation of a program for the use of palivizumab in a general pediatrics office and evaluate adherence to the 2009 American Academy of Pediatrics (AAP) guidelines.

Methods: Pediatricians in a large practice were educated in the diagnosis and management of bronchiolitis, with specific attention to the AAP’s palivizumab administration guidelines. During the 2009–2010 and 2010–2011 respiratory syncytial virus seasons, children were systematically identified and enrolled for palivizumab administration. Indication for administration was determined by gestational age, age at the beginning of the respiratory syncytial virus season, pertinent diagnoses, and presence of risk factors.

Results: In the 2009–2010 season, 161 children were enrolled to receive palivizumab, 86 of whom (53%) conformed with AAP guidelines. In contrast, in 2010–2011, a total of 85 children were enrolled to receive palivizumab, and 73 (86%) conformed with the guidelines. As a consequence, the total cost of palivizumab (US $: 511 559 vs 1 500 670) and the cost per child (US $: 6018 vs 9438) were lower in 2010–2011 than in 2009–2010. However, of the children selected within the AAP guidelines, only 29% received the appropriate number of doses, whereas 62% and 9% received fewer or excessive doses, respectively; these findings were similar for the 2 seasons.

Conclusions: In a primary practice, use of palivizumab outside of the AAP guidelines was frequent and manifested as inadequate indications or inadequate number of doses. The former improved with education and standardization of care (suggesting provider problems), while the latter did not (suggesting system problems). Additional interventions are required.

KEY WORDS
  • RSV
  • bronchiolitis
  • primary care
  • palivizumab
  • public health
  • Abbreviations:
    AAP —
    American Academy of Pediatrics
    CHD —
    congenital heart disease
    CHMPC —
    Children’s Hospital Medical Practice Corporation
    CHNO —
    Children’s Hospital of New Orleans
    CLD —
    chronic lung disease
    GA —
    gestational age
    HSCHD —
    hemodynamically significant congenital heart disease
    RSV —
    respiratory syncytial virus
    • Accepted September 7, 2011.
    • Copyright © 2012 by the American Academy of Pediatrics

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    Pediatrics
    Vol. 129, Issue 1
    1 Jan 2012
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    Use of Palivizumab in Primary Practice
    Keith M. Perrin, Rodolfo E. Bégué
    Pediatrics Jan 2012, 129 (1) 55-61; DOI: 10.1542/peds.2010-2991

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    Use of Palivizumab in Primary Practice
    Keith M. Perrin, Rodolfo E. Bégué
    Pediatrics Jan 2012, 129 (1) 55-61; DOI: 10.1542/peds.2010-2991
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