Background and Aims The Canadian Registry of Synagis® (CARESS) tracks palivizumab use and respiratory outcomes in high-risk 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.