Respiratory syncytial virus bronchiolitis in newborns: a new era in prevention

Respiratory syncytial virus (RSV) prevention in early infancy has entered a new era with the availability of highly effective preventive strategies, particularly the long-acting monoclonal antibody nirsevimab. Real-world evidence from large population-based studies has confirmed a major reduction in RSV-related hospitalizations, pediatric intensive care admissions, and respiratory support requirements among infants receiving nirsevimab during their first RSV season. A recent French nationwide study involving more than 160,000 infants further sup- ports the substantial clinical impact of this approach in routine practice. Maternal RSVpreF vaccination also represents an important preventive opportunity, especially when administered early enough during pregnancy to optimize transplacental antibody transfer and neonatal protection. Current evidence therefore supports the in- tegration of both strategies into modern RSV prevention programs, with nirsevimab offering predictable protec- tion independent of pregnancy timing and maternal vaccine uptake. The availability of effective immunoprophy- laxis is reshaping pediatric RSV prevention and opens the possibility of substantially reducing the burden of severe bronchiolitis during infancy. In Italy, the implementation of uniform national strategies for nirsevimab administration and maternal RSV vaccination will be essential to ensure equitable access, organizational efficiency, and maximal public health impact.