Management and Prevention Strategies for Respiratory Syncytial Virus (RSV) Bronchiolitis in Infants and Young Children: A Review of Evidence-Based Practice Interventions

Allison C. Cooper; Nancy Cantey Banasiak; Patricia Jackson Allen

Disclosures

Pediatr Nurs. 2003;29(6) 

In This Article

Prevention

Currently, there are two methods of preventing RSV infection in infants and children that are at an increased risk for developing a severe infection. RSV-IGIV (RespiGam, Massachusetts Public Health Biologic Laboratories, and MedImmune, Inc, Gaithersburg, MD) was approved for use by the FDA in 1996 for the prevention of severe RSV infection in those children less than 24 months of age with chronic lung disease or premature birth (35 weeks gestation) (AAP, 1998). RSV-IGIV was the first agent clinically approved for the prophylaxis of severe RSV infections. RSV-IGIV consists mostly of immunoglobulin G and trace amounts of immunoglobulin A and M (Sandritter & Kraus, 1997). In one of the larger studies conducted by the PREVENT Study Group children 24 months of age with chronic lung disease and/or 35 weeks gestational age received a monthly infusions of RSV-IGIV (750 mg/kg/dose). The study found a 41% reduction in hospitalization rates, a 53% decrease in days of hospitalization due to RSV, and a 60% decrease in the number of days requiring supplemental oxygen (The PREVENT Study Group, 1997). RSV-IGIV should not be administered to those children with chronic heart disease due to the fact that efficacy has not been established in this patient population. RSV-IGIV is not recommended for administration in children that have had a previously severe adverse reaction associated with human immunoglobulin products or in children with immunoglobulin A deficiency because of the possibility of anaphylaxis (Sandritter & Kraus, 1997). Monthly intravenous prophylaxis is also relatively expensive and time consuming (AAP, 1998).

In 1998, palivizumab (Synagis7; MedImmune Inc., Gaithersburg, MD), a humanized RSV neutralizing monoclonal antibody, received FDA approval for the prevention of LRTI in infants at high risk for developing severe RSV disease (Sorrentino et al., 2000). As part of the Impact-RSV trial, it was found that palivizumab reduced RSV hospitalizations by 55% for all children enrolled, by 39% for children with chronic lung disease, and by 80% for children with a history of prematurity without chronic lung disease (Impact-RSV Study Group, 1998; Sorrentino et al., 2000). Synagis is not a human blood product and, therefore, does not have the risks associated with blood products, as does RSV-IGIV. Synagis is also easier to administer than RSV-IGIV (1 intramuscular injection/month vs. 4-hour intravenous infusion), and it can be administered in an outpatient setting (AAP, 1998).

The most important aspect of RSV prevention is education. It is necessary for both parents and caregivers of infants to be informed of the importance of reducing exposure and transmission of the disease, especially when the infant is high risk. The most important method for reducing the transmission of RSV, as well as other infectious diseases, is frequent and consistent handwashing, especially when caring for children who are high risk for severe RSV infection (AAP, 1998). Additional preventative measures include eliminating cigarette smoke from the child's environment and limiting exposure to crowds and other children (e.g., day care).

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