Can we improve the targeting of respiratory syncytial virus (RSV) prophylaxis in infants born 32-35 weeks' gestational age with more informed use of risk factors?

• Published in: The journal of maternal-fetal & neonatal medicine 2015-07, Vol.28 (10), p.1133-1141
• Main Authors: Carbonell-Estrany, Xavier, Fullarton, John R., Rodgers-Gray, Barry S., Gooch, Katherine L., Vo, Pamela G., Figueras-Aloy, Jose
• Format: Article
• Language: English
• Subjects: Antiviral Agents - therapeutic use; Area Under Curve; Bronchiolitis; Female; Gestational Age; hospitalisation; Hospitalization; Humans; Infant; Infant, Newborn; Infant, Premature; Male; NNT; Numbers Needed To Treat; palivizumab; premature infants; Respiratory Syncytial Virus Infections - etiology; Respiratory Syncytial Virus Infections - prevention & control; Respiratory Syncytial Viruses; Risk Assessment; Risk Factors
• ISSN: 1476-7058; 1476-4954
• DOI: 10.3109/14767058.2014.947573

Objective: To evaluate the key risk factors for respiratory syncytial virus (RSV) hospitalisation in 32-35 weeks' gestational age (wGA) infants. Methods: Published risk factors were assessed for predictive accuracy (area under the receiver operating characteristic curve [ROC AUC]) and for number needed to treat (NNT). Results: Key risk factors included: proximity of birth to the RSV season; having siblings; crowding at home; day care; smoking; breast feeding; small for GA; male gender; and familial wheezing/eczema. Proximity of birth to the RSV season appeared the most predictive. Risk factors models from Europe and Canada were found to have a high level of predictive accuracy (ROC AUC both >0.75; NNT for European model 9.5). A model optimised for three risk factors (birth ±10 weeks from start of RSV season, number of siblings ≥2 years and breast feeding for ≤2 months) had a similar level of prediction (ROC AUC: 0.776; NNT: 10.2). An example two-risk factor model (day care attendance and living with ≥2 siblings