Impact of palivizumab on admission to the ICU for respiratory syncytial virus bronchiolitis: A national survey

Study objectives: To assess the effect of palivizumab licensing for respiratory syncytial virus (RSV) prophylaxis on national pediatric ICU (PICU) admissions and on the need for mechanical ventilation due to RSV bronchiolitis in Israel. Design: Prospective national surveillance survey. Setting: All PICUs in Israel. Patients or participants: All patients admitted to a PICU because of acute bronchiolitis in two consecutive RSV seasons (November 2000 to April 2001 and November 2001 to April 2002). Methods: Data on demographic and epidemiologic factors and RSV prophylaxis status were collected for every infant with bronchiolitis who was admitted to a PICU in Israel in the year before and after issuance of the Israel Ministry of Health recommendation for palivizumab prophylaxis (January 2001). Results: One hundred five patients were admitted to a PICU because of RSV bronchiolitis in the year before the recommendations were issued, and 123 patients were admitted in the year after they were issued. Mechanical ventilation was required by 33 and 42 children, respectively. Gestational age was > 32 weeks in 92.9% and 83.9% of the admitted patients, respectively, and 89% and 91% of the patients, respectively, were free of chronic lung disease (CLD). In both periods, 83% of the children who were admitted to a PICU did not meet the American Academy of Pediatrics criteria for RSV prophylaxis. Conclusions: Most of the children with severe RSV bronchiolitis needing PICU admission from 2000 to 2002 born at term did not have CLD and were not candidates for RSV prophylaxis according to the current recommendations.