PRS23 COST AND RESOURCE UTILIZATION OF RESPIRATORY SYNCYTIAL VIRUS (RSV) OR WINTER UNSPECIFIED BRONCHIOLITIS OR PNEUMONIA (UBP) HOSPITALIZATIONS DURING THE FIRST YEAR OF LIFE AMONG LATE PRETERM AND FULL-TERM INFANTS

Objective This article aims to compare respiratory syncytial virus (RSV) immunoprophylaxis (IP) use and RSV hospitalization rates (RSVH) in preterm and full-term infants without chronic lung disease of prematurity or congenital heart disease before and after the recommendation against RSV IP use in preterm infants born at 29 to 34 weeks' gestational age (wGA). Study Design Infants in commercial and Medicaid claims databases were followed from birth through first year to assess RSV IP and RSVH, as a function of infant's age and wGA. RSV IP was based on pharmacy or outpatient medical claims for palivizumab. RSVH was based on inpatient medical claims with a diagnosis of RSV. Results Commercial and Medicaid infants 29 to 34 wGA represented 2.9 to 3.5% of all births. RSV IP use in infants 29 to 34 wGA decreased 62 to 95% (p < 0.01) in the 2014–2015 season relative to the 2013–2014 season. Compared with the 2013–2014 season, RSVH increased by 2.7-fold (p = 0.02) and 1.4-fold (p = 0.03) for infants aged <3 months and 29 to 34 wGA in the 2014–2015 season with commercial and Medicaid insurance, respectively. In the 2014–2015 season, RSVH for infants 29 to 34 wGA were two to seven times higher than full-term infants without high-risk conditions. Conclusion Following the 2014 RSV IP guidance change, RSV IP use declined and RSVH increased among infants born at 29 to 34 wGA and aged <3 months.

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1526. The economic impact of respiratory syncytial virus (RSV) in infants in the United States: systematic literature review

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1706 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S764-S764

Author(s):

Diana Bowser ◽

Reissa Gervasio ◽

Elizabeth Glaser ◽

Dhwani Harihan ◽

Katie Rowlands ◽

...

Keyword(s):

Respiratory Syncytial Virus ◽

Literature Review ◽

Preterm Infants ◽

Gestational Age ◽

Medical Costs ◽

Full Term ◽

Late Preterm ◽

Term Infants ◽

Late Preterm Infants ◽

Syncytial Virus

Abstract Background Respiratory syncytial virus (RSV) is a human orthopneumovirus spread by direct contact with symptomatic, infected individuals. An estimated 587,000 RSV LRTIs result in inpatient or outpatient encounters annually among US infants (Rainisch et al 2019). The health care costs associated with RSV include medical costs to insurers, governments, and households, travel, and loss of wages. Initial summary of Inpatient and Ambulatory Medical Costs p Infant w RSV.JPG Jun 17th, 2020 @ 2:44 PM 852 x 572 122.3 Kb Methods A systematic literature review of the costs associated with children who have RSV was conducted. Following PRISMA methodology, key search terms were searched within article titles and abstracts through PubMed, EconLit, and Scopus. A total of 1,942 unique abstracts were screened independently by two authors and reduced to 180 articles after applying inclusion and exclusion criteria. The number of included articles after reviewing the full text was 66. Costing results were adjusted to USD2020 based on the Medical Care Consumer Price Index. Results Costing results were reported mainly for medical costs in inpatient settings. Initial results show that annual mean inpatient costs per RSV patient range among individual studies from $9,825 (SD=$25,227) for full term infants to $26,120 (SD unspecified) for late preterm infants (Table 1). Costing results vary by gestational age, with late preterm infants having an annual mean inpatient cost almost 1.6 times that of a full term infant. Inpatient costs for RSV infants are higher for commercial pay versus Medicaid, for both full term infants (commercial mean=$16,489 SD=$31,068, Medicaid mean=$10,291 SD=$64,625) and late preterm infants (commercial mean=$23,836; SD=$43,709, Medicaid mean=$18,864 SD=$28,716). Annual RSV ambulatory costs per infant vary between $4,371 (SD=$13,411) and $19,963 (SD=$27,269), depending on gestational age. Other relevant RSV costs include preventative drug costs, such as palivizumab (average $11,954 per infant). Conclusion The literature describes the economic impact of RSV primarily for hospitalization of children with underlying comorbidities. There is a need to better understand costing results for RSV, including the burden in ambulatory settings and indirect costs to families affected. Disclosures All Authors: No reported disclosures

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Levels of Predominant Intestinal Microorganisms in 1 Month-Old Full-Term Babies and Weight Gain During the First Year of Life

Nutrients ◽

10.3390/nu13072412 ◽

2021 ◽

Vol 13 (7) ◽

pp. 2412

Author(s):

Sonia González ◽

Marta Selma-Royo ◽

Silvia Arboleya ◽

Cecilia Martínez-Costa ◽

Gonzalo Solís ◽

...

Keyword(s):

Weight Gain ◽

Gut Microbiota ◽

Early Life ◽

Later Life ◽

Full Term ◽

First Year ◽

Term Infants ◽

Term Newborns ◽

Infant Weight Gain ◽

First Year Of Life

The early life gut microbiota has been reported to be involved in neonatal weight gain and later infant growth. Therefore, this early microbiota may constitute a target for the promotion of healthy neonatal growth and development with potential consequences for later life. Unfortunately, we are still far from understanding the association between neonatal microbiota and weight gain and growth. In this context, we evaluated the relationship between early microbiota and weight in a cohort of full-term infants. The absolute levels of specific fecal microorganisms were determined in 88 vaginally delivered and 36 C-section-delivered full-term newborns at 1 month of age and their growth up to 12 months of age. We observed statistically significant associations between the levels of some early life gut microbes and infant weight gain during the first year of life. Classifying the infants into tertiles according to their Staphylococcus levels at 1 month of age allowed us to observe a significantly lower weight at 12 months of life in the C-section-delivered infants from the highest tertile. Univariate and multivariate models pointed out associations between the levels of some fecal microorganisms at 1 month of age and weight gain at 6 and 12 months. Interestingly, these associations were different in vaginally and C-section-delivered babies. A significant direct association between Staphylococcus and weight gain at 1 month of life was observed in vaginally delivered babies, whereas in C-section-delivered infants, lower Bacteroides levels at 1 month were associated with higher later weight gain (at 6 and 12 months). Our results indicate an association between the gut microbiota and weight gain in early life and highlight potential microbial predictors for later weight gain.

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Respiratory Syncytial Virus Epidemiology in a Birth Cohort from Kilifi District, Kenya: Infection during the First Year of Life

The Journal of Infectious Diseases ◽

10.1086/425040 ◽

2004 ◽

Vol 190 (10) ◽

pp. 1828-1832 ◽

Cited By ~ 53

Author(s):

D. James Nokes ◽

Emelda A. Okiro ◽

Mwanajuma Ngama ◽

Lisa J. White ◽

Rachel Ochola ◽

...

Keyword(s):

Respiratory Syncytial Virus ◽

Birth Cohort ◽

First Year ◽

Syncytial Virus ◽

First Year Of Life

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Health Care Resource Utilization of Late Premature Versus Term Infants With Bronchiolitis

Clinical Pediatrics ◽

10.1177/0009922820920012 ◽

2020 ◽

Vol 59 (8) ◽

pp. 778-786

Author(s):

David Greenberg ◽

Ron Dagan ◽

Eilon Shany ◽

Shalom Ben-Shimol ◽

Noga Givon-Lavi

Keyword(s):

Health Care ◽

Respiratory Syncytial Virus ◽

Preterm Infants ◽

Resource Utilization ◽

Health Care Resource ◽

Term Infants ◽

Late Preterm Infants ◽

Health Care Resource Utilization ◽

Duration Of Hospitalization ◽

Syncytial Virus

It is controversial whether it is cost-beneficial for late preterm infants to receive respiratory syncytial virus prophylaxis. This study compares community and hospital health care resource utilization (HCRU) of late premature infants (33-36 weeks gestational age) with term infants (>36 weeks gestational age) hospitalized with bronchiolitis. This was a retrospective, population-based, observational study spanning a 9-year period (2004-2012). HCRU data were obtained from the Health Maintenance Organization “Clalit” and included duration of hospitalization, physician visits, laboratory tests, and treatments. Compared with term infants, late preterm infants had significantly longer duration of hospitalization and higher admission rates to pediatric intensive care unit. They also had higher rates of mean outpatients clinic visits, total outpatient clinic and specialist visits, blood chemistry, and virology testing. HCRU of term infants with bronchiolitis was also substantial, indicating that they also can greatly benefit from respiratory syncytial virus prophylaxis. These findings can guide stakeholders in decisions concerning the prevention of bronchiolitis and will be useful in performing further cost-benefit analysis.

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749. Healthcare Utilization After Hospitalization for Respiratory Syncytial Virus or Unspecified Bronchiolitis in the First Year of Life

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.756 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S268-S269

Author(s):

Joel Ledbetter ◽

Lance Brannman ◽

Sally Wade ◽

David Diakun ◽

Tara Gonzales ◽

...

Keyword(s):

Respiratory Syncytial Virus ◽

Healthcare Utilization ◽

Healthcare Resource Utilization ◽

Urgent Care ◽

First Year ◽

Chi Squared ◽

Ed Visits ◽

Syncytial Virus ◽

First Year Of Life

Abstract Background Respiratory syncytial virus (RSV) is the leading cause of infant hospitalizations and risk varies by gestational age (GA). Healthcare utilization following early hospitalizations caused by RSV (RSVH) or unspecified bronchiolitis (UBH) is not well understood. This study examined healthcare resource utilization (HRU) across GA categories within 12 months after an initial RSVH or UBH occurring in the first year of life. Methods Infants born July 1, 2009 to June 30, 2015 were identified in the MarketScan Commercial (COM) and Multistate Medicaid (MED) databases and assigned to GA categories using DRG and ICD codes and to an initial hospitalization cohort using inpatient claim diagnosis codes (RSVH, UBH without RSVH, or COMP [a comparator without RSVH or UBH]). Index dates (first admission dates for hospitalized infants) were assigned to COMP infants using times from birth to index dates among RSVH infants. HRU (hospitalizations, outpatient pharmacy fills, and visits for emergency department [ED], urgent care, wellness, other office or outpatient) excluded index hospitalizations and was assessed from 14 days post-index (or discharge if later) through 12 months post-index. Results were propensity score weighted to balance pre-index characteristics (age, sex, region, GA, birth hospitalization characteristics) across cohorts. Proportions were compared with chi-squared tests. Results Among all infants (all GA categories combined), the proportions of RSVH and UBH cohorts with follow-up hospitalizations or ED visits were greater (P < 0.05) than COMP (hospitalizations: COM +5.8%, +9.3%; MED +9.1%, +12.0%; ED visits: COM +15.8%, +16.2%; MED +14.4%, +17.1%). Follow-up hospitalizations in COM and MED and ED visits in COM declined with greater GA (Figures 1 and 2). HRU in other categories (fills, visits) was significantly (P < 0.05) greater among RSVH or UBH infants relative to COMP for nearly all GA categories in both COM and MED. Conclusion Infants hospitalized for RSV or UB in their first year of life had greater use of inpatient and outpatient resources in the 12 months following their initial hospitalizations compared with nonhospitalized infants. Inpatient care during follow-up was greatest among infants born at earlier GA. Funded by AstraZeneca Disclosures J. Ledbetter, AstraZeneca: Speaker’s Bureau, Speaker honorarium. L. Brannman, AstraZeneca: Employee, Salary and Stocks. S. Wade, Wade Outcomes Research and Consulting: Employee, Salary. D. Diakun, Truven Health Analytics, an IBM Company: Employee, Salary. T. Gonzales, AstraZeneca: Employee, Salary and Stocks. A. Kong, Truven Health Analytics, an IBM Company: Employee, Salary.

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The Effect of Birth Month on the Risk of Respiratory Syncytial Virus Hospitalization in the First Year of Life in the United States

The Pediatric Infectious Disease Journal ◽

10.1097/inf.0000000000000250 ◽

2014 ◽

Vol 33 (6) ◽

pp. e135-e140 ◽

Cited By ~ 12

Author(s):

Patricia Calderón Lloyd ◽

Larissa May ◽

Daniel Hoffman ◽

Richard Riegelman ◽

Lone Simonsen

Keyword(s):

United States ◽

Respiratory Syncytial Virus ◽

The United States ◽

First Year ◽

Birth Month ◽

Syncytial Virus ◽

First Year Of Life

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Infection by the respiratory syncytial virus in infants and young children at high risk

Cardiology in the Young ◽

10.1017/s1047951105000545 ◽

2005 ◽

Vol 15 (3) ◽

pp. 256-265 ◽

Cited By ~ 13

Author(s):

Damien Bonnet ◽

Achim A. Schmaltz ◽

Timothy F. Feltes

Keyword(s):

Respiratory Syncytial Virus ◽

High Risk ◽

Respiratory Tract ◽

Lung Disease ◽

Chronic Lung Disease ◽

Lower Respiratory Tract ◽

First Year ◽

Syncytial Virus ◽

First Year Of Life ◽

Infants And Young Children

The respiratory syncytial virus is the most common cause of infection of the lower respiratory tract in infants and young children, and is the leading cause of hospitalisation and death due to viral illness during the first year of life. In otherwise healthy infants, the virus usually causes only mild respiratory illness, but premature babies and infants with chronic lung disease, those with congenitally malformed hearts, or those who are immunodeficient, are at increased risk of serious illness, hospitalisation, and death. Recent infection with the virus is also associated with increased postoperative complications after corrective surgery for congenitally malformed hearts. No effective vaccine is currently available, and treatment is limited to supportive therapy. Prevention in groups deemed to be at high-risk, therefore, is essential. In addition to measures for control of infection, prophylactic immunotherapy is indicated in selected patients. Palivizumab (Synagis®) is a monoclonal antibody indicated for the prevention of serious viral disease of the lower respiratory tract in premature infants, those with chronic lung disease, and those with haemodynamically significant congenital cardiac lesions. Palivizumab is given intramuscularly, usually as a monthly injection during the so-called “season”. In a recent international, randomised, double-blind, placebo-controlled trial in 1,287 children less than or equal to 2 years old with haemodynamically significant congenital cardiac malformations, prophylaxis achieved a relative reduction of 45 per cent in the incidence of antigen-confirmed viral-related hospitalisation, and reduced the duration of hospital stay by 56 per cent. National and international guidelines, therefore, now recommend routine prophylaxis in the first year of life in children with haemodynamically significant congenital cardiac disease.

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Neonatal gut and respiratory microbiota: coordinated development through time and space

10.1101/247122 ◽

2018 ◽

Author(s):

Alex Grier ◽

Andrew McDavid ◽

Bokai Wang ◽

Xing Qiu ◽

James Java ◽

...

Keyword(s):

Infant Health ◽

Term Infant ◽

Full Term ◽

First Year ◽

Body Site ◽

Clinical Practices ◽

Dynamic Interactions ◽

Term Infants ◽

First Year Of Life ◽

Respiratory Microbiota

ABSTRACTBackground: Postnatal development of the microbiota in early life influences immunity, metabolism, neurodevelopment and long-term infant health. Microbiome development occurs at multiple body sites, each with distinct community compositions and functions. Associations between microbiota at multiple sites represent an unexplored influence on the infant microbiome. Here, we examined co-occurrence patterns of gut and respiratory microbiota in pre- and full-term infants over the first year of life, a period critical to neonatal development and risk of respiratory diseases.Results: Gut and respiratory microbiota collected as longitudinal rectal, throat and nasal samples from 38 pre-term and 44 full-term infants were first clustered into community state types (CSTs) on the basis of their composition. Multiple methods were used to relate the occurrence of CSTs to several measures of infant maturity, including gestational age (GA) at birth, week of life (WOL), and post menstrual age (PMA: equal to GA plus WOL). Manifestation of CSTs followed one of three patterns with respect to infant maturity. First, chronological: independent of infant maturity (GA) at birth, and strongly associated with post-natal age (WOL). Second, idiosyncratic: primarily dependent on maturity (GA) at birth, with persistent differences in CST occurrence between pre- and full-term infants through the first year of life. Third, convergent: CSTs appear earlier in infants with greater maturity (GA) at birth, but after a sufficient post-natal interval their occurrence in pre-term infants reaches parity with full-term infants. The composition of CSTs was highly dissimilar between different body sites, but the CST of any one body site was highly predictive of the CSTs at other body sites. There were significant associations between the abundance of individual taxa at each body site and the CSTs of the other body sites, which persisted after stringent control for the non-linear effects of infant maturity. Significant canonical correlations exist between the microbiota composition at each pair of body sites, with the strongest correlations between more proximal locations.Conclusion: Cross-body site associations of developing infant microbiota suggest the importance of research and clinical practices that focus on dynamic interactions between multiple microbial communities to elucidate and promote systemic microbiota development.

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