Physician opinion mixed on 2014 AAP guidelines for RSV immunoprophylaxis
According to a recent study in Clinical Pediatrics, use of immunoprophylaxis treatment for severe respiratory syncytial virus among pediatric physicians widely followed the 2012 AAP recommendations; while opinion on the updated 2014 recommendations varied.
“A majority of pediatric specialists agree with and implement the commonly recognized recommendations for [respiratory syncytial virus (RSV)] immunoprophylaxis for select high-risk patients,” Deborah M. Friedman, MD, of New York Medical College, and colleagues wrote. “However, regarding the updated 2014 AAP guidance, agreement and implementation among the various pediatric specialists was decidedly mixed.”
The researchers developed and administered specialty-specific surveys to 203 neonatologists, 156 pediatric cardiologists, 138 pediatricians and 58 pediatric pulmonologists. Their initial survey gauged physician perception of the 2012 AAP guidelines for immunoprophylaxis for severe RSV. A follow-up survey was sent after the 2014 guidelines were released.
Study results showed that the majority of pediatric physicians followed practice patterns in line with the 2012 guidelines. More than 82.7% of pediatric physicians reported a high clinical need for RSV immunoprophylaxis treatments for preterm infants. About 77.4% of pediatricians and neonatologists reported that the need for RSV immunoprophylaxis was low unless the infant was aged younger than 3 months at the beginning of RSV season, or had more than one risk factor based on the 2012 AAP guidelines.
In the follow-up survey, 60.2% of pediatricians and 53.3% of neonatologists agreed with a change in the 2014 guidelines that stated infants born at 32 weeks’ to 34 weeks’ gestational age who are younger than 3 months at the start of RSV season and have preschool-aged siblings are no longer recommended for RSV immunoprophylaxis.
However, another change, stating that children born between 29 and 31 weeks, who will be aged younger than 6 months at the start of RSV season, should not receive RSV immunoprophylaxis, was supported by fewer pediatricians (32.5%) and neonatologists (37.4%).
Most pediatricians and neonatologists reported that their practice patterns would change due to the recommendations made in the tighter 2014 guidelines for administering RSV immunoprophylaxis.
“The results from this study provide a basis to improve education about risk for severe RSV disease and to evaluate changes in physician use of RSV immunoprophylaxis based on the recent 2014 AAP guidance,” Friedman and colleagues wrote. – by David Costill
Disclosure: Friedman reports serving on the speakers bureau for and receiving travel expenses from MedImmune/AstraZeneca. Please see the full study for a list of all other authors’ relevant financial disclosures.