Palivizumab prophylaxis in 'late preterm' newborns

In the last decades the preterm birth rate rose more than 20%, largely because of an increase among deliveries of 'late preterm' infants, i.e. those born at 34 to 36 weeks gestational age. Late preterm infants are more susceptible to infection by pathogens, such as respiratory syncytial virus (RSV), possibly because of the immaturity of both the respiratory system and the immune system. As a consequence, similar risks of serious RSV illness have been observed in late preterm and preterm (born ≤ 32 wGA) infants, higher when compared with full-term infants. Prevention of RSV infection includes palivizumab, which is proven to be effective in reducing the overall hospitalization rate for RSV-induced bronchiolitis in preterm neonates. In order to maximize the cost-effectiveness of this preventive approach, the American Academy of Pediatrics (AAP) has suggested the administration of palivizumab to infants born between 32 0/7 and 34 6/7 wGA with at least one risk factor and born 3 months before or during RSV season. Because a variety of environmental and demographic traits may affect the severity of RSV epidemics in different Nations, a European risk scoring tool has been developed, based on the 'local' most important risk factors. Therefore, recommendations and guidelines must be modulated in each country, determining their appropriateness in the individual setting.