In Reply.—

We appreciate the comments of Manzoni et al regarding our article related to palivizumab use in very premature infants in the neonatal intensive care unit. Manzoni et al report respiratory syncytial virus (RSV)-related hospitalizations in 2.3% of high-risk infants treated with palivizumab in Italy despite rigorous adherence to the current American Academy of Pediatrics guidelines for palivizumab use. Their findings are comparable with reports of RSV-related hospitalizations in high-risk infants treated with palivizumab in the United States and other countries.2–5 

It is interesting that Manzoni et al observed that all RSV-related hospitalizations in their high-risk infants occurred only after the 19th day of palivizumab administration. Based on the findings of our study, we suspect that RSV infection in some of these infants might have been associated with suboptimal palivizumab concentrations. Although 71% of very premature infants (born at <30 weeks' gestation) in our...

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