1. Critical Appraisal
Groothuis, J., Bauman, J., Malinoski, F., & Eggleston, M. (2008). Strategies for Prevention of
RSV Nosocomial Infection. Journal of Perinatology, 28, 319-323.
Level 1b
Prescott Jr., W. A., Doloresco, F., Brown, J., & Paladino, J. A. (2010). Cost Effectiveness of
Respiratory Syncytial Virus Prophylaxis: A Critical and Systemic Review.
Pharmacoeconomics, 28(4), 279-293.
Level 1b
Use of RSV Prophylaxis
April Abaecherli, BSN, RN and Jamie Faulkner, BSN, RN
Clinical Question
P: Neonates admitted to a hospital
with RSV/Bronchiolitis
I: Administration of
Synagis(palivizumab) to all
neonates
C: Administration of
Synagis(palivizmub) to high risk
neonates only
O: Decrease the number of RSV/
Bronchiolitis admissions
T: Over one year?
Among neonates admitted to a hospital for
RSV/Bronchiolitis, does administering
Synagis (palivizumab) to all neonates
versus only high-risk neonates decrease
the number of RSV/Bronchiolitis
admissions over a year?
Clinical Issues/ Background
• Respiratory Syncytial
Virus(RSV)/Bronchiolitis is the leading
cause of infant hospitalization in the United
States
• RSV Prophylaxis is possible with the use
of Synagis(palivizumab)
• Synagis(palivizumab) is extremely
expensive, and requires multiple
administrations during RSV season to be
effective
• Synagis(palivizumab) is currently only
recommended, by the American Academy
of Pediatrics, for use in “high-risk”
neonates
• Could administering Synagis(palivizumab)
to all neonates decrease the number of
hospital admissions related to
RSV/Bronchiolitis?
Acknowledgements
Carol A. Shaw, RN, MSN
Teresa A. Couch, MSN, Med, RN
Nellie Bess, BSN, MEd, RN
Also, we would like to thank the RN
Residency and SRU educators for this
opportunity.
Findings
• Based upon current research for RSV
prophylaxis to be most cost effective it
should be administered to “high-risk”
populations only and also be administered
during peak outbreak months
• High-risk populations defined as premature
infants less than 32 weeks gestational age,
and infants or children less than 2 years
old with chronic lung disease or congenital
heart disease.
• RSV season generally begins in November
or December, peaks in January or
February, and calms during March or April
• Use of Synagis(palivizumab) may be
beneficial to all infants in the hospital,
especially those who have close contact
with an infant who develops RSV, but
further research is needed
• Synagis(palivizumab) has been shown to
reduce the number of RSV-related
hospitalizations in high-risk populations
Recommendations
• More research needs to be conducted to
determine if RSV prophylaxis benefits
outweigh the costs associated with
administration in all neonates.
• Until further research is conducted the
only neonates that should receive RSV
prophylaxis are those falling into the high-
risk category, and it is essential that it be
administered “in season” for the infant to
receive the full benefit and to be most cost
effective.
Search Strategy
Keywords
• Bronchiolitis
• Synagis (palivizumab)
• Neonates
Databases
• PubMed
• Ebsco
Strategic Initiative
Outcomes: Develop and embed tools for
measuring and improving outcomes for 100
diseases and complex disorders and
achieve at least 20% improvement for at
least 50% of them and best-in-class
outcomes for 20 high impact diseases and
complex disorders.
Cost: Be a model for lowering heath-care
costs. Reduce inflation-adjusted and
severity-adjusted cost per patient encounter
by at least 5%