740. Impact of the 2014 American Academy of Pediatrics Guidance on Respiratory Syncytial Virus Hospitalization Rates for Preterm Infants <29 Weeks Gestational Age at Birth: 2012–2016
Session: Poster Abstract Session: Respiratory Infections: Viral
Thursday, October 4, 2018
Room: S Poster Hall
  • Goldstein_Truven 29 wGA_IDWeek Poster_Final_27Sep18.pdf (112.7 kB)
  • Background: In 2014, the American Academy of Pediatrics stopped recommending RSV immunoprophylaxis (RSV IP) for otherwise healthy infants 29–34 weeks gestational age (wGA), while continuing to recommend RSV IP for infants born at <29 wGA. The decline in RSV IP and associated increase in RSV hospitalizations (RSVH) among infants 29–34 wGA have been described previously, but potential effects of the 2014 guidance change on preterm infants <29 wGA are unknown. This study compared 2012–14 and 2014–16 outpatient RSV IP use as well as RSVH rates relative to term infants among otherwise healthy <29 wGA infants.

    Methods: Infants born from 7/1/2011 to 6/30/2016 were followed from birth hospitalization discharge through their first year of life in the MarketScan Commercial (COM) and Multistate Medicaid (MED) databases. DRG and ICD codes identified term and <29 wGA infants at birth. RSV IP receipt was derived from pharmacy and outpatient medical claims (inpatient RSV IP data were unavailable). RSVH were derived from inpatient medical claims. RSVH IP use and RSVH were assessed across 3 chronologic age (CA) groups: <3 months, 3–<6 months, and 6–<12 months. RSVH rate ratios for 2012–14 and 2014–16 were calculated for <29 wGA infants using healthy term infants 0–<12 months of age as a reference category.

    Results: Outpatient RSV IP receipt fell after 2014 for <29 wGA infants across all CA categories, with the greatest decline observed among infants <3 months CA (Table 1). Greater RSVH rates for <29 wGA infants relative to term infants were observed after 2014 (Figures 1 and 2), with infants <3 months CA experiencing the greatest percentage increases in relative RSVH risks.

    Conclusion: Outpatient RSV IP decreased and RSVH relative to term infants increased among otherwise healthy <29 wGA infants following the 2014 policy change, even though RSV IP continued to be recommended. The effects were greatest for infants <3 months CA and those insured by Medicaid.

    Funded by AstraZeneca

    Table 1. Percentage of <29 wGA infants receiving outpatient RSV IP in 2012–14 vs. 2014–16





    % Decline



    % Decline

    <3 mos, %







    3 to <6 mos, %







    6 to <12 mos, %







    *P-value <0.05

    Mitchell Goldstein, MD, Loma Linda University Children’s Hospital, Loma Linda, CA, Leonard R. Krilov, MD, Children’s Medical Center, NYU Winthrop, Mineola, NY, Jaime Fergie, MD, Driscoll Children's Hospital, Corpus Christi, TX, Lance Brannman, PhD, AstraZeneca, Gaithersburg, MD, Christopher S. Ambrose, MD, MBA, Department of US Medical Affairs, AstraZeneca, Gaithersburg, MD, Sally Wade, MPH, Wade Outcomes Research and Consulting, Salt Lake City, UT and Amanda Kong, MPH, Truven Health Analytics, an IBM Company, Cambridge, MA


    M. Goldstein, AstraZeneca/MedImmune: Consultant , Research grant and Research support .

    L. R. Krilov, AstraZeneca/MedImmune: Consultant , Research grant and Research support .

    J. Fergie, AstraZeneca/MedImmune: Consultant and Speaker's Bureau , Research grant and Research support .

    L. Brannman, AstraZeneca: Employee , Salary and Stocks .

    C. S. Ambrose, AstraZeneca: Employee , Salary and Stocks .

    S. Wade, Wade Outcomes Research and Consulting contracted by Truven: Consultant , Consulting fee .

    A. Kong, Truven Health Analytics, an IBM Company: Employee , Salary .

    Findings in the abstracts are embargoed until 12:01 a.m. PDT, Wednesday Oct. 3rd with the exception of research findings presented at the IDWeek press conferences.