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  1. 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%