We appreciate the opportunity to comment on the issues raised by an AstraZeneca employee regarding the revised American Academy of Pediatrics (AAP) Guidance on the use of palivizumab for respiratory syncytial virus (RSV) prophylaxis.

First, we agree preterm infants experience an RSV hospitalization rate that increases with decreasing gestational age. The critical question is, “How great is the increase in risk for preterm infants relative to term infants?” In the prospective study of 132 000 infants by Hall et al and reproduced in Table 1 of the newly published AAP Technical Report, the risk of RSV hospitalization over a 6-month season for infants born at ≥37 weeks is 5.3 per 1000 (95% confidence interval [CI], 4.9–5.8). Corresponding rates for infants with gestational age ≥35, 32–34, 29–31, and <29 weeks were 5.1 (95% CI, 4.7–5.5), 6.9 (95% CI, 4.3–10.1), 6.3 (95% CI, 2.0–12.4), and 19.3 (95% CI, 8.4–34.0) per...

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