Fergie J, Gonzales T, Jiang X, Fryzek J, Rizzo CP. Respiratory syncitial virus hospitalizations (RSVH) and all-cause bronchiolitis hospitalizations (BH) among 29-34 weeks gestational age (wGA) preterm infants before and after the 2014 American Academy of Pediatrics (AAP) immunoprophylaxis policy change using the Children’s Hospital Association’s Pediatric Health Information System (PHIS). Poster presentation at IDWeek, Washington, DC, October 2–6, 2019.
Background: In 2014, the AAP stopped recommending RSV immunoprophylaxis for otherwise healthy 29-34 wGA preterm infants. We sought to examine the risk of RSVH and BH among 29-34 wGA infants before the AAP policy change (November 1, 2010- March 31, 2014) and after (November 1, 2014-March 31, 2017) using PHIS hospital level encounter data from 51 US children’s hospitals.
Methods: Our study population included the first November to March RSVH (ICD9=079.6, 480.1, 466.11, ICD10=B97.4, J12.1, J21.0) or BH (RSVH or unspecified bronchiolitis (ICD9=466.19, ICD10=J21.1, J21.8, J21.9)) among infants 6 months of age or younger admitted to one of the PHIS hospitals between November 1, 2010 and March 31, 2017. The proportion of RSVH and BH by wGA categories (22-28 wGA, 29-34 wGA, 35-36 wGA, and term infants (37+ wGA)) were compared in the time period before and after 2014 . Frequencies and proportions were calculated overall for all infants and by demographic and clinical factors for 29-34 wGA infants for RSVH and BH, separately. Statistically significant differences before and after the AAP policy were compared using Chi-square test or Wilcoxon rank-sum test, as appropriate.
Results: 96,281 infants with BH, including 67,570 RSVH, were studied. Among infants with known gestational age, the proportions of hospitalizations for RSVH and BH increased after the AAP policy for all wGA categories, except for term infants (Table). 29-34 wGA infants represented 8.7% of all RSVH before the AAP policy and 14.2% of all RSVH after the policy (p<0.0001). No significant differences were found by gender or co-morbidity for 29-34 wGA infants. Among 29-34 wGA infants, the ICU admission rate increased significantly for RSVH (from 54.5% to 64.2%, p<0.0001) and BH (from 46.7% to 54.5%, p<0.0001) after the policy. The median RSVH length of stay (from 6 to 7 days, p=0.047) and median adjusted estimated cost (from $14,077 to $16,058, p=0.038) increased significantly after the policy.
Conclusion: RSV and all-cause bronchiolitis hospitalizations and their severity increased among 29-34 wGA preterm infants in the 3 year period following the 2014 AAP policy change on RSV immunoprophylaxis.