Neonatal Intensive Care Drug Manual

It is reasonable to consider use in Australia of palivizumab 15 mg/kg/dose from April to August (5 doses) in the following infants:

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  Ex-preterm infants with chronic lung disease (oxygen or respiratory support at 36 weeks post menstrual age);
  
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  Preterm infants born ≤26 weeks gestation;
  
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  Infants with haemodynamically significant congenital heart disease between 0 to <6 months age; and
  
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  Infants at risk of severe RSV bronchiolitis including infants with moderate to severe pulmonary conditions particularly those requiring continued respiratory and/or oxygen support.
  
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  Children with severe pulmonary abnormality or neuromuscular disease that impairs the ability to clear secretions from the upper airways may be considered for prophylaxis in the first year of life.
  
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  Children younger than 24 months who will be profoundly immunocompromised during the RSV season may be considered for prophylaxis.
  
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  Insufficient data are available to recommend palivizumab prophylaxis for children with cystic fibrosis or Down syndrome.
  

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  Infants born during the RSV season may require fewer doses. [10, 12]
  
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  Prophylaxis should be discontinued in any child who experiences a breakthrough RSV hospitalization. [10, 12]
  
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  Prophylaxis is not required in congenital heart disease where there is mild cardiomyopathy or surgically corrected disease (unless medication required for heart failure). [3]
  
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  After cardiopulmonary bypass surgery, give a dose once child is stable (serum concentration markedly reduced after these procedures); resume doses each month if prophylaxis still required. [3]