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Evaluation of Compliance With Palivizumab Recommendations in a Multicenter Study of Young Children Presenting to the Emergency Department With Bronchiolitis

Mansbach, Jonathan MD*; Kunz, Sarah BA; Acholonu, Uchechi BA; Clark, Sunday MPH, ScD; Camargo, Carlos A. Jr MD, DrPH

doi: 10.1097/01.pec.0000278406.75815.d3
Original Articles

Objective: Monthly palivizumab injections from November to March decrease risk of respiratory syncytial virus (RSV)-related hospitalization during RSV season in high-risk infants born less than 35 weeks of gestation. Our objective was to investigate compliance with the American Academy of Pediatrics (AAP) recommendations for palivizumab prophylaxis among children who present to the emergency department (ED) with bronchiolitis.

Methods: Seventeen centers, from 9 US states, performed a prospective, observational study of ED patients less than 2 years with an attending physician diagnosis of bronchiolitis. Researchers conducted a structured interview, followed by a chart review, and a 2-week follow-up phone call.

Results: Of 825 eligible children, 624 (73%) were enrolled. According to AAP recommendations, 35 children (6%) should have received palivizumab, but only 17 (49%; 95% confidence interval, 31%-66%) did. Prophylaxis with palivizumab did not differ by US region (P > 0.50). The ED clinical presentations were similar when comparing those children that did and did not receive prophylaxis (all P > 0.27). Those receiving palivizumab were more likely to come to the ED using systemic corticosteroids (22% vs 7%; P = 0.003) and to be treated with corticosteroids in the ED (31% vs 15%; P = 0.02). The 2 groups were at similar risk of hospitalization (52% vs 39%; P = 0.11).

Conclusions: According to parental report, only half of children presenting to the ED with bronchiolitis who met AAP criteria for palivizumab prophylaxis received this monoclonal antibody. Emergency department visits provide an untapped opportunity for staff to educate families and communicate with PCPs about RSV prophylaxis.

*Department of Medicine, Children's Hospital Boston and †Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA.

Address correspondence and reprint requests to Jonathan Mansbach, MD, Children's Hospital Boston, Main Clinical Building 9 South, 9157, Boston, MA 02115. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.