Respiratory Syncytial Virus Prophylaxis With Palivizumab Is Not Associated With Improved Lung Function in Infants of Very Low Birth Weight at Early School Age

Background

Prematurity and infection with respiratory syncytial virus (RSV) are major risk factors for impaired lung function beyond the neonatal period.

Research Question

What are the long-term effects of palivizumab immunoprophylaxis in the first year of life on lung function and frequency of bronchitis episodes in 5- to 6-year-old preterm infants?

Study Design and Methods

Preterm infants with a birth weight < 1,500 g (very low-birth weight infants [VLBWIs]) were enrolled in a German Neonatal Network cohort study between 2009 and 2016. Children were examined by a single follow-up team at 5 to 6 years of age. VLBWIs who received at least five doses of palivizumab were compared with children who never received palivizumab. Analyses were stratified by bronchopulmonary dysplasia (BPD) and gestational age. We analyzed FVC, FEV₁, FEV₁ to FVC ratio, and the risk of respiratory tract infections at 5 to 6 years of age via univariate analyses and linear and logistic regression models.

Results

Of 1,986 VLBWIs with follow-up at 5 to 6 years of age, 951 infants (48%) received immunoprophylaxis with palivizumab. Children with BPD (n = 1,019) showed a much lower FEV₁ than children without BPD (median FEV₁ z score, –1.51 vs –1.09; P < .001). However, FEV₁ in children with BPD was not altered by palivizumab (median FEV₁ z score in 698 children with BPD who received palivizumab, –1.57 [interquartile range, –0.75 to –2.43] vs in 320 children with BPD who did not receive palivizumab, –1.37 [interquartile range, –0.69 to –2.25]; P = .1). As for FEV₁, we did not find any protective effects of palivizumab for other end points or in other risk groups.

Interpretation

Palivizumab immunoprophylaxis in VLBWIs is not associated with improved lung function or lower rates of respiratory tract infections in early school-age infants.