Respiratory Syncytial Virus Prophylaxis in Infants With Congenital Diaphragmatic Hernia in the Canadian Respiratory Syncytial Virus Evaluation Study of Palivizumab, 2005–2017

Abstract

Background Infants with congenital diaphragmatic hernia (CDH) are at an increased risk of respiratory morbidity from recurrent respiratory tract infections including those from respiratory syncytial virus (RSV). Prospective studies on RSV prophylaxis in CDH infants are limited. We determined the risk of respiratory illness– and RSV-related hospitalizations (RIH and RSVH, respectively) among infants prophylaxed for CDH, standard indications (SIs) and those without increased risk (NR). Methods The prospective Canadian Respiratory Syncytial Virus Evaluation Study of Palivizumab (CARESS) registry was searched for infants who received palivizumab during 12 RSV seasons (2005–2017) in Canada. Cox proportional hazards analyses were conducted to compare RIH and RSVH risks across the groups adjusted for potential confounders. Results In total, 21 107 infants (201 CDH, 389 NR, and 20 517 SI) were included. RIH incidences were 10.0% (CDH), 2.1% (NR), and 6.2% (SI). CDH patients had a significantly higher RIH hazard compared with NR (hazard ratio [HR], 3.6 [95% confidence interval {CI}, 1.5–8.8]; P = .005) but not SI (HR, 1.2 [95% CI, .8–2.0]; P = .379). RSVH incidences were 0.6%, 0.3%, and 1.5% for CDH, NR, and SI, respectively. RSVH risk was similar across groups (SI: HR, 0.0, P = .922; NR: HR, 0.0, P = .934). Conclusions CDH infants had a 3-fold increased risk of RIH compared to NR but not SI infants. RSVH risk was similar with low RSVH incidences across all groups, implying that CDH infants may benefit from palivizumab during the RSV season, similar to other high-risk groups. Clinical Trials Registration NCT00420966.

Generation of neutralizing and non-neutralizing monoclonal antibodies against H7N9 influenza virus

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Long-term follow-up of patients with congenital diaphragmatic hernia

“…The role of palivizumab in preventing RSV in CDH survivors has recently been evaluated showing that CDH neonates benefit from vaccination. 50 In July 2023, the monoclonal antibody, nirsevimab, was approved by the US Food and Drug Administration to protect newborns against RSV. 51 The Advisory Committee on Immunization Practices and the Centers for Disease Control and Prevention in the USA unanimously approved the administration of nirsevimab for protection against RSV in neonates.…”

Respiratory syncytial virus bronchiolitis in congenital diaphragmatic hernia: A systematic review of prevalence rates and palivizumab prophylaxis

“…Titles and abstracts of selected papers were then assessed in full for eligibility, excluding 29 papers. Ten publications [21][22][23][24][25][26][27][28][29][30] remained, from which 7 more papers [21][22][23][24][25][26][27] were subsequently excluded (see Table E1 for reasons for exclusion) We included 3 final studies, [28][29][30] all of which were retrospective cohorts.…”