Palivizumab immunization of premature infants with bronchopulmonary dysplasia in a day hospital

Introduction. To date, Рalivizumab is the only approved monoclonal antibody preparation used to prevent the development of respiratory syncytial virus (RSV) infection. The aim of the work is to evaluate the benefits of immunization with Palivizumab in premature infants with bronchopulmonary dysplasia in a day hospital of the Federal Center.

Materials and methods. One hundred seven infants of different gestational age at birth were immunized with Palivizumab in the day patient department of hospital-replacing technologies. The preparation was administered to infants at risk for the formation of severe consequences of an RSV infection.

Results. Of the 107 children hospitalized in the day hospital, 74 premature babies were diagnosed with bronchopulmonary dysplasia (69%). Before immunization all infants were consulted by pediatrician, pulmonologist, and if necessary, other specialists. Discussion. The length of stay of children in a day hospital ranged from 2 to 3.5 hours on average. Each child stayed with their parents in a separate room. During this time period, the patient received the full range of the services associated with immunization.

Conclusion. Thus, immunization with Palivizumab in a day hospital of the Federal Center allows implementing a comprehensive multidisciplinary and individual approach to each infant, without exposing him to an undesirable risk of infection, in compliance with the principle of staged nursing of premature infants for patients with a new form of bronchopulmonary dysplasia who need a long follow-up observation.

Contribution:
Kharitonova N.A., Davydova I.V. — concept and design of the study;
Kharitonova N.A., Nesterovich M.I., Illarionova M.S., Seliverstova A.A., Potekhina T.V., Bondar V.A. — collection and processing of the material;
Kharitonova N.A., Mitish M.D. — statistical processing;
Basargina M.A., Zimina E.P. — editing.
All co-authors  — approval of the final version of the article, responsibility for the integrity of all parts of the article.

Acknowledgment. The study had no sponsorship.

Conflict of interest. The authors declare no conflict of interest.

Received: December 14, 2022
Accepted: January 17, 2023
Published: February 28, 2023

1. Davydova I.V. Longterm consequences of respiratory syncytial viral infection in early childhood. Pediatriya im. G.N. Speranskogo. 2018; 97(6): 159–64. https://doi.org/10.24110/0031-403X-2018-97-6-159-164 (in Russian)

2. Li Y., Wang X., Blau D.M., Caballero M.T., Feikin D.R., Gill C.J., et al. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in children younger than 5 years in 2019: a systematic analysis. Lancet. 2022; 399(10340): 2047–64. https://doi.org/10.1016/S0140-6736(22)00478-0

3. Odumade O.A., Van Haren S.D., Angelidou A. Implications of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic on the epidemiology of pediatric respiratory syncytial virus infection. Clin. Infect. Dis. 2022; 75(Suppl. 1): 130–5. https://doi.org/10.1093/cid/ciac373

4. Taleb S.A., Thani A., Ansari K., Yassine H.M. Human respiratory syncytial virus: pathogenesis, immune responses, and current vaccine approaches. Eur. J. Clin. Microbiol. Infect. Dis. 2018; 37(10): 1817–27. https://doi.org/10.1007/s10096-018-3289-4

5. Esposito S., Abu-Raya B., Bonanni P., Cahn-Sellem F., Flanagan K.L., Torres F.M., et al. Coadministration of anti-viral monoclonal antibodies with routine pediatric vaccines and implications for nirsevimab use: a white paper. Front. Immunol. 2021; 12: 708939. https://doi.org/10.3389/fimmu.2021.708939

6. Esposito S., Abu-Raya B., Eugenio B., Flanagan K.L., Torres F.M., Tsolia M., et al. RSV prevention in all infants: which is the most preferable strategy? Front. Immunol. 2022; 13: 880368. https://doi.org/10.3389/fimmu.2022.880368

7. Ovsyannikov D.Yu., Krsheminskaya I.V. Immunoprophylaxis of respiratory syncytial virus infection: why is it important from an epidemiological and clinical point of view. Neonatologiya: novosti, mneniya, obuchenie. 2017; (2): 34–49. https://doi.org/10.24411/2308-2402-2017-00026 (in Russian)

8. Watkiss E.R. Pathogenesis of respiratory syncytial virus. Curr. Opin. Virol. 2012; 2(3): 300–5. https://doi.org/10.1016/j.coviro.2012.01.008

9. Collins P.L., Graham B.S. Viral and host factors in human respiratory syncytial virus pathogenesis. J. Virol. 2008; 82(5): 2040–55. https://doi.org/10.1128/JVI.01625-07

10. Belderbos M.E., Houben M.L., Wilbrink B., Lentjes E., Bloemen E.M., Kimpen J.L.L., et al. Cord blood vitamin D deficiency is associated with respiratory syncytial virus bronchiolitis. Pediatrics. 2011; 127(6): e1513–20. https://doi.org/10.1542/peds.2010-3054

11. Al-Toum R., Bdour S., Ayyash H. Epidemiology and clinical characteristics of respiratory syncytial virus infections in Jordan. J. Trop. Pediatr. 2006; 52(4): 282–7. https://doi.org/10.1093/tropej/fml002

12. Karr C.J., Rudra C.B., Miller K.A., Gould T.R., Larson T., Sathyanarayana S., et al. Infant exposure to fine particulate matter and traffic and risk of hospitalization for RSV bronchiolitis in a region with lower ambient air pollution. Environ. Res. 2009; 109(3): 321–7. https://doi.org/10.1016/j.envres.2008.11.006

13. Bradley J.P., Bacharier L.B., Bonfiglio J.A., Schechtman K.B., Strunk R., Gregory S., et al. Severity of respiratory syncytial virus bronchiolitis is affected by cigarette smoke exposure and atopy. Pediatrics. 2005; 115(1): e7–14. https://doi.org/10.1542/peds.2004-0059

14. Groskreutz D.J., Monick M.M., Babor E.C., Nyunoya T., Varga S.M., Look D.C., et al. Cigarette smoke alters respiratory syncytial virus-induced apoptosis and replication. Am. J. Respir. Cell Mol. Biol. 2009; 41(2): 189–98. https://doi.org/10.1165/rcmb.2008-0131OC

15. Evangelisti M., Cangiano G., Nenna R., Nicolai A., Frassanito A., Papasso S., et al. Air pollution and bronchiolitis from 2004 to 2014 in Rome. Eur. Respiratory J. 2015; PA4505. https://doi.org/10.1183/13993003.congress-2015.PA4505

16. Scheltema N.M., Kavelaars X.M., Thorburn K., Hennus M.P., Van Woensel J.B., Van der Ent C.K., et al. Potential impact of maternal vaccination on life-threatening respiratory syncytial virus infection during infancy. Vaccine. 2018; 36(31): 4693–700. https://doi.org/10.1016/j.vaccine.2018.06.021

17. Ananworanich J., Heaton P.M. Bringing preventive RSV monoclonal antibodies to infants in low- and middle-income countries: challenges and opportunities. Vaccines (Basel). 2021; 9(9): 961. https://doi.org/10.3390/vaccines9090961

18. Gilbert B.E., Patel N., Lu H., Liu Y., Guebre-Xabier M., Piedra P.A., et al. Respiratory syncytial virus fusion nanoparticle vaccine immune responses target multiple neutralizing epitopes that contribute to protection against wild-type and palivizumab-resistant mutant virus challenge Vaccine. 2018; 36(52): 8069–78. https://doi.org/10.1016/j.vaccine.2018.10.073

19. Robbie G.J., Zhao L., Mondick J., Losonsky G., Roskos L.K. Population pharmacokinetics of palivizumab, a humanized anti-respiratory syncytial virus monoclonal antibody, in adults and children. Antimicrob. Agents. Chemother. 2012; 56(9): 4927–36. https://doi.org/10.1128/AAC.06446-11

20. Domachowske J.B., Khan A.A., Esser M.T., Jensen K., Takas T., Villafana T., et al. Safety, tolerability and pharmacokinetics of MEDI8897, an extended half-life single-dose respiratory syncytial virus prefusion F-targeting monoclonal antibody administered as a single dose to healthy preterm infants. Pediatr. Infect. Dis. J. 2018; 37(9): 886–92. https://doi.org/10.1097/INF.0000000000001916

21. Davydova I.V., Keshishyan E.S., Lobzin Yu.V., Bal’tserovich N.B., Fedorova O.S., Demskaya E.E. Safety and efficacy of palivizumab in children at high risk of severe respiratory syncytial viral infection in Russia and Belarus. Pediatriya im. G.N. Speranskogo. 2019; 98(4): 164–71. https://doi.org/10.24110/0031-403X-2019-98-4-164-171 (in Russian)

22. Yi H., Lanctôt K.L., Bont L., Bloemers B.L.P., Weijerman M., Broers C., et al. Respiratory syncytial virus prophylaxis in Down syndrome: a prospective cohort study. Pediatrics. 2014; 133(6): 1031–7. https://doi.org/10.1542/peds.2013-3916

23. Davydova I.V., Fisenko A.P., Pozharishchenskaya V.K., Kazakova K.A., Basargina E.Yu., Bondar’ V.A. A new form of bronchopulmonary dysplasia: current realias. Doktor.Ru. 2020; 19(10): 6–9. https://doi.org/10.31550/1727-2378-2020-19-10-6-9 (in Russian)