861 RSV Hospitalization in Infants with Neuromuscular Disease in the Canadian Registry of Synagis(R) (Caress) Following Prophylaxis (2005-2011)

Abstract

Background and Aims The Canadian Registry of Synagis® (CARESS) tracks palivizumab use and respiratory outcomes in highrisk infants, including those with neuromuscular impairments (NMI). We compared respiratory illness (RI) and respiratory syncytial virus positive hospitalization (RSVH) rates in NMI infants versus: 1) those with other underlying medical disorders (MD) and 2) those prophylaxed for standard indications (SD). Methods A prospective, observational registry of infants from 30 Canadian sites who received ≥1 dose of palivizumab during the 2005-2011 RSV seasons. Utilization and RI events were collected monthly throughout each season. Results 10452 infants were recruited (NMI: 118, 1.1%; MD: 1443, 13.8%; SD: 8891, 85.1%). There were statistically significant group differences (p<0.05) in: enrolment weight and age, gestational age, birth weight, proportions of: Caucasians, daycare attendance, smoking exposure, siblings, multiple birth, >5 individuals in the household, and history of atopy. NMI infants tended to have a less complex neonatal course. Compliance was similar across the three groups. The NMI group had higher RI hospitalization rates than MD or SD (17.8% versus 9.6% and 5.8%, p<0.0005), as well as RSVH (5.62% versus 1.98% and 1.49%, p<0.0005). A Cox proportional hazard analysis showed that having NMI increased the risk of first RSVH compared to infants in the SD group (hazard ratio=4.47, 95% CI 1.96-10.18, p<0.0005). Conclusions NMI infants comprise a very high risk cohort for RI and RSV-related hospitalization and should be considered for palivizumab prophylaxis to reduce incurred morbidities as recommended by the American Academy of Pediatrics and other international advisory bodies.