[2003] [1908] Respiratory Syncytial Virus (RSV) Immunoprophylaxis in a High-Risk Urban Population: A Comparison of Delivery Strategies and Outcomes

Ivan L. Hand, Donna M. Geiss, Lawrence M. Noble, Alan M. Shotkin. Department of Pediatrics/ Division of Neonatology, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY.

BACKGROUND: RSV infections account for a significant amount of clinic visits and hospitalizations during the first year of life, especially in the premature infant and infant with chronic lung disease. Prophylaxis with Synagis, a monoclonal antibody directed against RSV, has been shown to decrease hospitalizations in these high-risk infants. In order to improve compliance with our immunoprophylaxis program we chose to implement a monthly home-based delivery system to administer the medication.
OBJECTIVE: To assess compliance and outcomes of a home-based delivery system as compared to a clinic-based delivery system for RSV prophylaxis.
DESIGN/METHODS: All infants meeting AAP criteria for RSV immunoprophylaxis received Synagis in a clinic-based program during 2000-2001 and a home-based program during 2001-2002. Medical records were reviewed for compliance data as well as unscheduled medical visits and hospitalizations. Data was analyzed using one-way ANOVA, t test and Chi Square.
RESULTS: There were 109 infants studied in our clinic-based program (2000-2001) and 127 infants studied in our home-based program (2001-2002). There was no significant difference in birthweight (1391± 594 vs. 1441 ± 573 gms, p=.51) or gestational age (29.8 ±3.5 vs 30.1 ±3.8 wks, p=.40) between the two groups. Compliance of the home-based group was 81.8% as compared with the clinic-based group of 61.6%, p = .001. Infants in the home-based program had less unscheduled medical visits than infants in the clinic-based program (3.5 vs 4.6, p=.042) during a one year period commencing from the start of the RSV season. Infants in the home-based program also had less hospitalizations during the RSV season (.26 vs .43, p=.009) than those in the clinic-based program. A sub-group analysis of infants who received all scheduled doses in both groups(n=155) demonstrated significantly less hospitalizations during the RSV season in the home-based group than in the clinic-based group (.25 vs. .62, p=.006).
CONCLUSIONS: Compliance with an immunoprophylaxis program was higher with a home-based delivery system as opposed to a clinic-based system. The home-based system was associated with a lower number of hospitalizations and unscheduled medical visits. Home-based delivery of RSV prophylaxis may be more efficacious in preventing disease through increased compliance as well as decreased exposure of the high-risk infant to the clinic environment.