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RSV Prophylaxis Guidelines

American Academy of Pediatrics Guidelines


Updated September 15, 2009

The American Academy of Pediatrics updated their guidelines for which children should receive RSV prophylaxis with Synagis in the 2009 Red Book and they now include:
  • Children less than two years of age with chronic lung disease.
  • Premature infants who were born at less than 28 weeks and who are less than twelve months old at the start of RSV season (October to May).
  • Premature infants who were born between 29-32 weeks and who are less than six months old at the start of RSV season.
  • Premature infants who were born between 32-35 weeks and who are less than three months old at the start of RSV season and who have at least one risk factors -- either they are attending daycare or they have a sibling less than five years old at home.
  • Certain children who are younger than 2 years with congenital heart disease, including congestive heart failure, pulmonary hypertension, and cyanotic heart disease.
  • Certain infants born before 35 weeks with congenital abnormalities of the airway or neuromuscular disease.
Since RSV infections are so common and the symptoms can be so severe, why doesn't everyone get Synagis? One of the reasons is that younger infants, especially if they were born premature, are most at risk of the serious complications of RSV infections. The other reason is the cost. Synagis injections cost about $900 a month and requires a monthly injection during RSV season.

Fortunately, most insurance companies do pay for RSV prophylaxis if your doctor feels that your child is high risk.

Where do you get Synagis injections? In our area, Synagis is usually available from our local Pediatric Pulmonologists (lung specialists), or from Synagis clinics at local major hospitals, especially those with a large Neonatal Intensive Care Unit. If you have a preemie that is going to be discharged around RSV season, then your doctors will likely talk to you about Synagis before your discharge and will likely give the first shot before you are sent home.

Whether or not your child is at high risk of having complications from an RSV infection, there are other ways to lessen the chances that your child will get infected. These include:

  • teaching your children and care providers to practice frequent handwashing, especially after using the bathroom (including diaper changes) and before eating. You should also frequently wash toys and other objects that your children put in their mouth and all other surfaces and dispose of tissues after wiping or blowing your child's nose.
  • avoiding close contact with other people who are sick. Make sure that your day care has a strict policy about excluding children with contagious illnesses. and don't let anyone smoke around your baby. If you do smoke, simply smoking outside is usually not enough to decrease your child's risk of problems.


American Academy of Pediatrics Policy Statement. Revised Indications for the Use of Palivizumab and Respiratory Syncytial Virus Immune Globulin Intravenous for the Prevention of Respiratory Syncytial Virus Infections. PEDIATRICS Vol. 112 No. 6 December 2003, pp. 1442-1446.

Red Book. 28th Edition. American Academy of Pediatrics. 2009 Report of the Committee on Infectious Diseases.

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