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CONTRIBUTIONS FROM THE MEMBER SOCIETIES
RE-EVALUATION OF PALIVIZUMAB USAGE IN ISRAEL
The new recommendations of the American Academy of Pediatrics (AAP) calling for a more limited and narrower usage of palivzumab (synagis) for the prevention of RSV in high risk groups have caused some confusion among pediatricians in Israel.
For the last decade several professional associations in Israel especially the Neonatology and The Pediatric Pulmonology Associations have advocated for a gradual expansion of the populations eligible for this expensive technology. While 14 years ago synagis was recommended for 200 infants born ^ than 28 weeks and those with chronic lung diseases, the funding for the prophylaxis was consistently increased and recently includes all infants born ^ 34 week + 7 days and included 2750 eligible infants.
In response to this reaction, The Israeli Pediatric Association, has nominated an ad hoc committee that included the chairmen of the relevant associations and societies (Neonatology, Pediatric Pulmonology, Pediatric Intensive Care, Public Health, Pediatric Infectious Diseases, and representative of the Ministry of Health (MOH).
The committee has reviewed the available data and reached the following conclusions:
1. Palivizumab has been proven effective in reducing hospitalizations following RSV infection at high risk groups.
2. Palivizumab has not been proven to reduce mortality associated with RSV infection.
3. While palivizumab prophylaxis reduces ICU hospitalizations due to RSV infections, it was not shown to reduce mechanical ventilation due to this infection.
4. The cost of prevention of 1 RSV hospitalization is different among different countries and could be quite high (^ 250,000$ in most models).
5. Palivizumab prophylaxis may decrease wheezing episodes among treated infants.
6. While palivizumab may reduce hospitalizations among high risk patients its usage is not supposed to significantly affect the total burden of RSV infection since the overwhelming part of RSV hospitalization affect otherwise healthy infants who are not eligible for RSV prophylaxis.
The committee's recommendations were as follows:
1. To continue during the present winter (2014-2015 season) with the same criteria.
2. To start with national data collection regarding the impact of RSV infection in Israel.
3. To establish immediately following the present winter a cost benefit analysis in order to determine whether the current criteria are cost effective. The analysis is supposed to be finished prior to the next season in order to define more correctly the population that is eligible for RSV prophylaxis.
References
1. Updated guidance for palivizumab prophylaxis among infants and young children at increased risk of hospitalization for respiratory syncytial virus infection. Pediatrics. 2014 Aug;134(2):e620-38.
2. Ralston SL et al. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics. 2014 Nov;134(5):e1474-502
3. American Academy of Pediatrics Committee on Infectious Diseases and Committee of Fetus and Newborn. Prevention of respiratory syncytial virus infections: indications for the use of palivizumab and update on the use of RSV-IGIV. Pediatrics. 1998;102:1211-1216.
4. Palivizumab, a Humanized Respiratory Syncytial Virus Monoclonal Antibody, Reduces Hospitalization From Respiratory Syncytial Virus Infection in High-risk Infants. The Impact-RSV Study Group. Pediatrics. 1998;102:531-7.
5. Feltes TL et al. Palivizumab Congenital Heart Disease Study: RSV Hospitalization Rates. J. Pediatr. 2003; 143(4):532-40.
6. Committee on Infectious Diseases. From the American Academy of Pediatrics: Policy statements — Modified recommendations for use ofpalivizumab for prevention of respiratory syncytial virus infections. Pediatrics. 2009 Dec;124(6):1694-701.
7. Hall CB, Weinberg GA, Blumkin AK, Edwards KM, Staat MA, Schultz AF, Poehling KA, Szilagyi PG, Griffin MR, Williams JV, Zhu Y, Grijalva CG, Prill MM, Iwane MK. Respiratory syncytial virus-associated hospitalizations among children less than 24 months of age. Pediatrics. 2013;132(2): e341-8.
8. Byington CL, Wilkes J, Sheng X, Korgenski K. Respiratory syncytial virus associated mortality in hospitalized United States infants and children less than 2 years of age. Presented at the Pediatric Academic Societies Annual Meeting; May 4-7, 2013; Washington, DC. Abstract 2915.181
9. Blanken MO, Rovers MM, Molenaar JM, Winkler-Seinstra PL, Meijer A, Kimpen JL, Bont L; Dutch RSV Neonatal Network. Respiratory syncytial virus and recurrent wheeze in healthy preterm infants. N Engl J Med. 2013.368:1791-9.
10. Yoshihara S, Kusuda S, Mochizuki H, Okada K, Nishima S, Simoes EA; C-CREW Investigators. Effect of palivizumab prophylaxis on subsequent recurrent wheezing in pre-term infants. Pediatrics. 2013 Nov;132(5):811-8.
11. Rietveld E, Steyerberg EW, Polder JJ, Veeze HJ, Vergouwe Y, Huysman MW, de Groot R, Moll HA. Passive immunisation against respiratory syncytial virus: a cost-effectiveness analysis. Arch Dis Child. 2010 Jul;95:493-8.
12. H. Cody Meissner and David W. Kimberlin. RSV Immu-noprophylaxis: Does the Benefit Justify the Cost? Pediatrics 2013;132:915-8.
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13. Andabaka T, Nickerson JW, Rojas-Reyes MX, Rueda JD, Bacic Vrca V, Barsic B. Monoclonal antibody for reducing the risk of respiratory syncytial virus infection in children. Cochrane Database Syst Rev. 2013 Apr 30;4: CD006602.
14. Prais D, Danino D, Schonfeld T, Amir J. Impact of palivi-zumab on admission to the ICU for respiratory syncytial virus bronchiolitis: a national survey. Chest. 2005 Oct;128(4):2765-71.
15. Kugelman A, Colin AA. Late Preterm Infants: Near Term But Still in a Critical Developmental Time Period. Pediatrics. 2013;132(4):741-51.
16. Greenberg D, Dagan R, Shany E, Bar-Ziv J, Givon-Lavi N. Increased risk for respiratory syncytial virus-associated, community-acquired alveolar pneumonia in infants
born at 31-36 weeks of gestation. Pediatr Infect Dis J. 2014;33:381-6.
17. Adam D et al. Prospective observational study of PICU hospitalizations due to RSV related bronchiolitis in 2008-2012. Presented at HIPAP conference, Tel Aviv Feb 2012.
18. Joseph L et al. Rates of hospitalization for RSV bronchiolitis for all degrees of prematurity in a single medical Center (Shaare-Zedek). Presented at HIPAK conference, Tel Aviv, Feb 2014.
19. Boyce TG, Mellen BG, Mitchel EF Jr, Wright PF, Griffin MR. Rates of hospitalization for respiratory syncytial virus infection among children in Medicaid. J Pediatr. 2000;137:865-70.
Prof. Eli Somekh, President, The Israeli Association of Pediatrics
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NEW EVIDENCES ABOUT THE EFFECTS OF HOME READING ENVIRONMENT ON THE ACTIVATION OF SPECIFIC BRAIN REGIONS SUPPORTING EMERGENT LITERACY
Giorgio Tamburlini
Centro per la salute del Bambino and Nati per Leggere program, Trieste, Italy
Literacy is the ability to utilize written information to expand and share knowledge in order to optimally function in society. Literacy acquisition involves a complex interplay of genetic, neurobiological and environmental factors, only the latter of which are directly modifiable (1). Emergent literacy is defined as the skills, knowledge, and attitudes supporting reading and writing that develop from infancy, when parents are often a child's first and most important teachers. Cognitively constructive home environments, especially prior to school entry, provide an essential foundation for emergent literacy. Parent-child reading exposes the child (and caregi-vers) to a larger variety of words than are otherwise spoken during everyday conversation, especially in low socioeconomic status households (2,3) and has been described as 'the single most important activity for developing the knowledge required for eventual success in reading' (4), explaining much of the variance in language, emergent literacy skills and achievement in children, independent of socioeconomic status. Parent-child reading since early infancy is widely advocated to promote cognitive development, and is recommended by several pediatric associations worldwide.
Although parent-child reading has been shown in behavioral and intervention studies to improve oral language and print concepts, quantifiable effects on the brain have not been previously studied. Hutton et al. (5) found an association between parent-child reading exposure and activation of brain areas supporting mental imagery and narrative comprehension. Nineteen 3- to 5-year-old children were selected from a longitudinal study of normal brain development and completed blood oxygen level-dependent functional magnetic resonance imaging using an age-appropriate story
listening task, where narrative alternated with tones. Higher reading exposure (using the validated StimQ-P Reading subscale score which measures frequency of reading and number and variety of children's books available at home) was positively correlated (p < 0.05, corrected) with neural activation in the left sided parietal-temporal-occipital association cortex, a "hub" region supporting semantic language processing, controlling for household income. It should be emphasized that these children, although 7 of them were from low income families had on average over a hundred of children's books at home.
The study for the first time demonstrated an association between home reading environment and activation of specific brain regions supporting emergent literacy during the prekindergarten period and provides neurobiological confirmation of the benefits of home reading shown by behavioural studies and provide further support to programs, such as Reach out and Read in the Unites States, Book start in the UK and Natiper Leggere in Italy, where paediatrician and other child professionals encourage parents to read to their babies since the first year of life. These programs are aimed at maximizing caregiver-child engagement through dialogic reading, where the child is stimulated to apply and exercise a broad range of language and executive function abilities.
1. National Research Council and Institute of Medicine. From neurons to neighborhoods: the science of early childhood development. Committee on Integrating the Science of Early Childhood Development. In Shonkoff JP, Phillips DA, editors. Washington, DC: National Academy Press, 2000.
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