To the Editor.—

We read with great interest the Pediatrics article published by Wu et al, which showed that very premature infants had sustained optimal protective levels of palivizumab (>40 μg/mL) serum concentrations only after the second dose, and up to 77% of the infants tested had no protective concentrations before the second dose. Because the ability of premature neonates to achieve efficient protection against respiratory syncytial virus (RSV) infection relies on serum palivizumab concentrations, one should suspect a considerable rate of inefficacy of palivizumab (in its currently recommended schedule) in preventing RSV infections in the first month of administration and, similarly, a con siderable rate of uncertainty of protection in the subsequent months, particularly in the days preceding the new administration.

The authors correctly claim that “[a]dditional studies are needed to establish the optimal timing of the initial dose and optimal dosing interval of palivizumab in this...

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