Increasing Rates of RSV Hospitalization among Preterm Infants: A Decade of Data

2021 ◽  
Author(s):  
Amanda M. Kong ◽  
Isabelle H. Winer ◽  
Nicole M. Zimmerman ◽  
David Diakun ◽  
Adam Bloomfield ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Policy Change ◽  
Relative Rate ◽  
Medical Conditions ◽  
Term Infants ◽  
Convenience Sample ◽  
Hospitalization Rates ◽  
Observational Cohort ◽  
Syncytial Virus ◽  
Rate Ratios

Objective In 2014, the American Academy of Pediatrics (AAP) changed its policy on the use of respiratory syncytial virus immunoprophylaxis (RSV-IP) so that RSV-IP was no longer recommended for use among infants without other medical conditions born >29 weeks gestational age (wGA). This study examines 10-year trends in RSV-IP and RSV hospitalizations among term infants and preterm infants born at 29 to 34 wGA, including the 5 RSV seasons before and 5 RSV seasons after the AAP guidance change. Study Design A retrospective observational cohort study of a convenience sample of infants less than 6 months of age during RSV season (November–March) born between July 1, 2008, and June 30, 2019, who were born at 29 to 34 wGA (preterm) or >37 wGA (term) in the IBM MarketScan Commercial and Multi-State Medicaid databases. We excluded infants with medical conditions that would independently qualify them for RSV-IP. We identified RSV-IP utilization along with RSV and all-cause bronchiolitis hospitalizations during each RSV season. A difference-in-difference model was used to determine if there was a significant change in the relative rate of RSV hospitalizations following the 2014 policy change. Results There were 53,535 commercially insured and 85,099 Medicaid-insured qualifying preterm infants and 1,111,670 commercially insured and 1,492,943 Medicaid-insured qualifying term infants. Following the 2014 policy change, RSV-IP utilization decreased for all infants, while hospitalization rates tended to increase for preterm infants. Rate ratios comparing preterm to term infants also increased. The relative rate for RSV hospitalization for infants born at 29 to 34 wGA increased significantly for both commercially and Medicaid-insured infants (1.95, 95% CI: 1.67–2.27, p <0.001; 1.70, 95% CI: 1.55–1.86, p <0.001, respectively). Findings were similar for all-cause bronchiolitis hospitalizations. Conclusion We found that the previously identified increase in RSV hospitalization rates among infants born at 29 to 34 wGA persisted for at least 5 years following the policy change. Key Points

scholarly journals Respiratory Syncytial Virus Hospitalizations among U.S. Preterm Infants Compared with Term Infants Before and After the 2014 American Academy of Pediatrics Guidance on Immunoprophylaxis: 2012–2016

2018 ◽  
Vol 35 (14) ◽  
pp. 1433-1442 ◽  
Author(s):  
Mitchell Goldstein ◽  
Leonard Krilov ◽  
Jaime Fergie ◽  
Kimmie McLaurin ◽  
Sally Wade ◽  
...  
Keyword(s):  
Respiratory Syncytial Virus ◽  
American Academy ◽  
Preterm Infants ◽  
Term Infants ◽  
American Academy Of Pediatrics ◽  
Before And After ◽  
Syncytial Virus ◽  
Using Data ◽  
Rate Ratios ◽  
Calculated Difference

Objective The objective of this study was to compare risk for respiratory syncytial virus (RSV) hospitalizations (RSVH) for preterm infants 29 to 34 weeks gestational age (wGA) versus term infants before and after 2014 guidance changes for immunoprophylaxis (IP), using data from the 2012 to 2016 RSV seasons. Study Design Using commercial and Medicaid claims databases, infants born between July 1, 2011 and June 30, 2016 were categorized as preterm or term. RSVH during the RSV season (November–March) were identified for infants aged <6 months and rate ratios (RRs) for hospitalization comparing preterm and term infants were calculated. Difference-in-difference models were fit to evaluate the changes in hospitalization risks in preterm versus term infants from 2012 to 2014 seasons to 2014 to 2016 seasons. Results In all seasons, preterm infants had higher RSVH rates than term infants. Seasonal RRs prior to the guidance change for preterm wGA categories versus term infants ranged from 1.6 to 3.4. After the guidance change, the seasonal RRs ranged from 2.6 to 5.6. In 2014 to 2016, the risk associated with prematurity of 29 to 34 wGA versus term was significantly higher than in 2012 to 2014 (P<0.0001 for commercial and Medicaid samples). Conclusion In infants aged <6 months, the risk for RSVH for infants 29 to 34 wGA compared with term infants increased significantly after the RSV IP recommendations became more restrictive.

scholarly journals Unintended Consequences Following the 2014 American Academy of Pediatrics Policy Change for Palivizumab Prophylaxis among Infants Born at Less than 29 Weeks' Gestation

2020 ◽  
Author(s):  
Mitchell Goldstein ◽  
Leonard R. Krilov ◽  
Jaime Fergie ◽  
Lance Brannman ◽  
Sally W. Wade ◽  
...  
Keyword(s):  
American Academy ◽  
Policy Change ◽  
Unintended Consequences ◽  
Difference In Difference ◽  
Term Infants ◽  
American Academy Of Pediatrics ◽  
Before And After ◽  
Medicaid Population ◽  
Syncytial Virus ◽  
Rate Ratios

Abstract Objective The aim of this study is to compare outpatient respiratory syncytial virus (RSV) immunoprophylaxis (IP) use and relative RSV hospitalization (RSVH) rates for infants <29 weeks' gestational age (wGA) versus term infants before and after the 2014 American Academy of Pediatrics (AAP) policy change. Study Design Infants were identified in the MarketScan Commercial and Multi-State Medicaid databases. Outpatient RSV IP receipt and relative <29 wGA/term hospitalization risks in 2012 to 2014 and 2014 to 2016 were assessed using rate ratios and a difference-in-difference model. Results Outpatient RSV IP receipt by infants <29 wGA and aged <3 months in the Commercial and Medicaid populations and those aged 3 to <6 months in the Medicaid population declined after 2014. Relative RSVH risks for infants <29 wGA were numerically greater after 2014, with infants aged <3 months and Medicaid infants experiencing the greatest increases. Difference-in-difference results indicated a significantly increased relative risk of RSVH for infants <29 wGA versus term (both cohorts aged 0 to <6 months) in the Medicaid-insured population (1.68, p = 0.0054). A nonsignificant increase of similar magnitude occurred in the commercially insured population (1.57, p = 0.2867). Conclusion The 2014 policy change was associated with a decrease in RSV IP use and an increase in RSVH risk among otherwise healthy infants <29 wGA.

scholarly journals The 2014–2015 National Impact of the 2014 American Academy of Pediatrics Guidance for Respiratory Syncytial Virus Immunoprophylaxis on Preterm Infants Born in the United States

2017 ◽  
Vol 35 (02) ◽  
pp. 192-200 ◽  
Author(s):  
Amanda Kong ◽  
Leonard Krilov ◽  
Jaime Fergie ◽  
Mitchell Goldstein ◽  
David Diakun ◽  
...  
Keyword(s):  
Respiratory Syncytial Virus ◽  
Preterm Infants ◽  
The United States ◽  
Full Term ◽  
First Year ◽  
Term Infants ◽  
Medical Claims ◽  
Hospitalization Rates ◽  
Before And After ◽  
Syncytial Virus

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.

scholarly journals 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

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S265-S266
Author(s):  
Mitchell Goldstein ◽  
Leonard R Krilov ◽  
Jaime Fergie ◽  
Lance Brannman ◽  
Christopher S Ambrose ◽  
...  
Keyword(s):  
American Academy ◽  
Preterm Infants ◽  
Gestational Age ◽  
Research Support ◽  
Term Infants ◽  
Medical Claims ◽  
American Academy Of Pediatrics ◽  
Syncytial Virus ◽  
Rate Ratios ◽  
Research Grant

Abstract 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 &lt;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 &lt;29 wGA are unknown. This study compared 2012–2014 and 2014–2016 outpatient RSV IP use as well as RSVH rates relative to term infants among otherwise healthy &lt;29 wGA infants. Methods Infants born from July 1, 2011 to June 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 &lt;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 three chronologic age (CA) groups: &lt;3 months, 3–&lt;6 months, and 6–&lt;12 months. RSVH rate ratios for 2012–2014 and 2014–2016 were calculated for &lt;29 wGA infants using healthy term infants 0–&lt;12 months of age as a reference category. Results Outpatient RSV IP receipt fell after 2014 for &lt;29 wGA infants across all CA categories, with the greatest decline observed among infants &lt;3 months CA (Table 1). Greater RSVH rates for &lt;29 wGA infants relative to term infants were observed after 2014 (Figures 1 and 2), with infants &lt;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 &lt;29 wGA infants following the 2014 policy change, even though RSV IP continued to be recommended. The effects were greatest for infants &lt;3 months CA and those insured by Medicaid. Funded by AstraZeneca Disclosures 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.

scholarly journals 1413. Trends in Risk of Respiratory Syncytial Virus Hospitalizations in Preterm Infants Over a 10-Year Period

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S713-S714
Author(s):  
Amanda M Kong ◽  
Isabelle H Winer ◽  
david diakun ◽  
Adam Bloomfield ◽  
Tara Gonzales
Keyword(s):  
Respiratory Syncytial Virus ◽  
Research Support ◽  
Term Infants ◽  
Major Health ◽  
Hospitalization Rates ◽  
American Academy Of Pediatrics ◽  
Ibm Watson ◽  
Syncytial Virus ◽  
Rate Ratios

Abstract Background The American Academy of Pediatrics (AAP) recommended respiratory syncytial virus (RSV) immunoprophylaxis (RSV-IP) to reduce the risk of severe RSV hospitalization (RSVH) for certain infants &lt; 35 weeks gestational age (wGA) until 2014, when the AAP no longer recommended use among infants born &gt;29 wGA without other medical conditions. Studies have shown that RSV-IP utilization subsequently decreased among these infants, as well as infants born &lt; 29 wGA from whom RSV-IP is still currently recommended. We described RSVH rates among preterm (PT) infants &lt; 35 wGA compared to term infants from 2008-2019. Methods We identified infants born between 7/1/2008 and 7/30/2019 in the MarketScan® Commercial and Multi-State Medicaid claims databases. Infants with a code for birth at &lt; 35 wGA were classified by wGA. Those with a code for full-term without major health problems were classified as term. Infants contributed follow-up time during the RSV season (November to March) while &lt; 6 months old, summarized as infant-seasons (days of follow-up during the RSV season divided by 151 [number of days in an RSV season]) (Table 1). Using diagnoses codes, we identified RSVH during each RSV season for infants &lt; 6 months. Unadjusted rate ratios comparing PT infants to term infants were calculated to account for seasonal variation in virus circulation. Number of Infants and Follow-up Time Results The number of infants contributing time at &lt; 6 months old during the RSV season and their follow-up time are shown in Table 1. There were 796 RSVH among Commercial PT infants, 6,486 RSVH among Commercial term infants, 2,501 RSVH among Medicaid PT infants, and 13,962 RSVH among Medicaid term infants during the 10 seasons in the database. RSVH rates for PT infants tended to increase over time, with the exception of the 2009-2010 season for Medicaid infants (Table 2). Rate ratios comparing PT to term infants also increased after the 2014 guidance change (Figure 1 and 2). The risk of 29-34 wGA infants compared to term infants approximately doubled in the 5 years after the guidance change (Table 2). Comparisons of RSV Hospitalization Rates for Preterm vs. Term Infants &lt; 6 Months Old Rate Ratios for RSV Hospitalization Rates for Commercial Infants &lt; 6 Months Old Rate Ratios for RSV Hospitalization Rates for Medicaid Infants &lt; 6 Months Old Conclusion After the change in AAP recommendations for RSV-IP, increases in RSVH rates for infants born at 29-34 wGA compared to term were found. This was also true for &lt; 29 wGA infants for whom RSV-IP is recommended, although the effect sizes were smaller. Disclosures Amanda M. Kong, DrPH, Sobi (Other Financial or Material Support, I am an employee of IBM Watson Health which received funding from Sobi to conduct this analysis.) david diakun, BS, Sobi (Grant/Research Support) Adam Bloomfield, MD, Sobi NA (Employee) Tara Gonzales, MD, Sobi, Inc. (Employee)

scholarly journals Hospitalizations for respiratory syncytial virus bronchiolitis in preterm infants at <33 weeks gestation without bronchopulmonary dysplasia: the CASTOR study

2012 ◽  
Vol 141 (4) ◽  
pp. 816-826 ◽  
Author(s):  
J.-B. GOUYON ◽  
J.-C. ROZÉ ◽  
C. GUILLERMET-FROMENTIN ◽  
I. GLORIEUX ◽  
L. ADAMON ◽  
...  
Keyword(s):  
Respiratory Syncytial Virus ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Full Term ◽  
Term Infants ◽  
Very Preterm Infants ◽  
Very Preterm ◽  
Hospitalization Rates ◽  
Syncytial Virus ◽  
Country Specific

SUMMARYThis study was conducted during the 2008–2009 respiratory syncytial virus (RSV) season in France to compare hospitalization rates for bronchiolitis (RSV-confirmed and all types) between very preterm infants (<33 weeks' gestational age, WGA) without bronchopulmonary dysplasia and full-term infants (39–41 WGA) matched for date of birth, gender and birth location, and to evaluate the country-specific risk factors for bronchiolitis hospitalization. Data on hospitalizations were collected both retrospectively and prospectively for 498 matched infants (249 per group) aged <6 months at the beginning of the RSV season. Compared to full-term infants, preterm infants had a fourfold [95% confidence interval (CI) 1·36–11·80] and a sevenfold (95% CI 2·79–17·57) higher risk of being hospitalized for bronchiolitis, RSV-confirmed and all types, respectively. Prematurity was the only factor that significantly increased the risk of being hospitalized for bronchiolitis. The risk of multiple hospitalizations for bronchiolitis in the same infant significantly increased with male gender and the presence of siblings aged ⩾2 years.

scholarly journals Impact of the 2014 American Academy of Pediatrics Immunoprophylaxis Policy on the Rate, Severity, and Cost of Respiratory Syncytial Virus Hospitalizations among Preterm Infants

2019 ◽  
Vol 37 (02) ◽  
pp. 174-183 ◽  
Author(s):  
Leonard R. Krilov ◽  
Jaime Fergie ◽  
Mitchell Goldstein ◽  
Lance Brannman
Keyword(s):  
Respiratory Syncytial Virus ◽  
American Academy ◽  
Preterm Infants ◽  
Policy Change ◽  
Temporal Trends ◽  
Patient Characteristics ◽  
Administrative Claims ◽  
Term Infants ◽  
American Academy Of Pediatrics ◽  
Syncytial Virus

Objective This study examined the rate, severity, and cost of respiratory syncytial virus (RSV) hospitalizations among preterm infants 29 to 34 weeks gestational age (wGA) versus term infants before and after a 2014 change in the American Academy of Pediatrics policy for RSV immunoprophylaxis. Study Design Preterm (29–34 wGA) and term infants born from July 2011 to March 2017 and aged < 6 months were identified in a U.S. commercial administrative claims database. RSV hospitalization (RSVH) rate ratios, severity, and costs were evaluated for the 2011 to 2014 and 2014 to 2017 RSV seasons. Postpolicy changes in RSVH risks for preterm versus term infants were assessed with difference-in-difference (DID) modeling to control for patient characteristics and temporal trends. Results In the DID analysis, prematurity-associated RSVH risk was 55% greater in 2014 to 2017 versus 2011 to 2014 (relative risk = 1.55, 95% confidence interval: 1.10–2.17, p = 0.011). RSVH severity increased among preterm infants after 2014 and was highest among those aged < 3 months. Differences in mean RSVH costs for preterm infants in 2014 to 2017 versus 2011 to 2014 were not statistically significant. Conclusion RSVH risk for preterm versus term infants increased after the policy change, confirming previous national analyses. RSVHs after the policy change were more severe, particularly among younger preterm infants.

scholarly journals Respiratory morbidity of preterm infants of less than 33 weeks gestation without bronchopulmonary dysplasia: a 12-month follow-up of the CASTOR study cohort

2013 ◽  
Vol 142 (7) ◽  
pp. 1362-1374 ◽  
Author(s):  
B. FAUROUX ◽  
J.-B. GOUYON ◽  
J.-C. ROZE ◽  
C. GUILLERMET-FROMENTIN ◽  
I. GLORIEUX ◽  
...  
Keyword(s):  
Risk Factors ◽  
Preterm Infants ◽  
Bronchopulmonary Dysplasia ◽  
Respiratory Morbidity ◽  
Study Cohort ◽  
Recurrent Wheezing ◽  
Term Infants ◽  
Independent Risk Factors ◽  
Syncytial Virus

SUMMARYThe aim of this study was to describe the incidence and risk factors for respiratory morbidity during the 12-month period following the first respiratory syncytial virus (RSV) season in 242 preterm infants [<33 weeks gestational age (GA)] without bronchopulmonary dysplasia and 201 full-term infants (39–41 weeks GA) from the French CASTOR study cohort. Preterm infants had increased respiratory morbidity during the follow-up period compared to full-terms; they were more likely to have wheezing (21% vs. 11%, P = 0·007) and recurrent wheezing episodes (4% vs. 1%, P = 0·049). The 17 infants (14 preterms, three full-terms) who had been hospitalized for RSV-confirmed bronchiolitis during their first RSV season had significantly more wheezing episodes during the follow-up period than subjects who had not been hospitalized for RSV-confirmed bronchiolitis (odds ratio 4·72, 95% confidence interval 1·71–13·08, P = 0·003). Male gender, birth weight <3330 g and hospitalization for RSV bronchiolitis during the infant's first RSV season were independent risk factors for the development of wheezing episodes during the subsequent 12-month follow-up period.

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

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.

scholarly journals Impact of Extending the Timing of Maternal Pertussis Vaccination on Hospitalized Infant Pertussis in England, 2014–2018

2020 ◽  
Author(s):  
Elise Tessier ◽  
Helen Campbell ◽  
Sonia Ribeiro ◽  
Norman K Fry ◽  
Colin Brown ◽  
...  
Keyword(s):  
Preterm Infants ◽  
Policy Change ◽  
Vaccine Coverage ◽  
Length Of Hospital Stay ◽  
Term Infants ◽  
Hospital Stays ◽  
Clinical Records ◽  
The Impact ◽  
Median Hospital ◽  
Optimal Window

Abstract Background In October 2012, a maternal pertussis vaccination program was introduced in England for women between 28 and 32 weeks of pregnancy. In April 2016, the recommended optimal window was extended to 20–32 weeks to improve vaccine coverage and protect preterm infants. This study assesses the impact of offering maternal pertussis vaccination earlier in pregnancy on hospitalized infant pertussis cases. Methods Hospitalized pertussis cases ≤60 days old in England were extracted from Hospital Episode Statistics pre- and post-policy change. Data were linked to laboratory-confirmed cases, and clinical records were reviewed where cases were not matched. Maternal vaccine status of identified cases was established. Median hospital duration was calculated, and a competing risk survival analysis was undertaken to assess multiple factors. Results A total of 201 cases were included in the analysis. Of the 151 cases with reported gestational age, the number of hospitalizations among full-term infants was 60 cases pre-policy and 62 cases post-policy, respectively, while preterm cases declined from 20 to 9 (P = .06). Length of hospital stay did not differ significantly after the policy change. Significantly longer hospital stays were seen in cases aged 0–4 weeks (median of 3 more days than infants aged 5–8 weeks), premature infants (median of 4 more days than term infants), and cases with coinfections (median of 1 more day than those without coinfection). Conclusions The number of preterm infants hospitalized with pertussis in England was halved after the policy change and preterm infants were no longer overrepresented among hospitalized cases.

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