Diana Fariña

Respiratory syncytial virus prophylaxis: cost-effective analysis in Argentina.

Introduction. Respiratory syncytial virus is a major cause of bronchiolitis during the first year of life. Preterm infants and patients with bronchopulmonary dysplasia (BPD) have a higher risk of hospitalization. The objective of this study was to assess the risk of hospitalization and to evaluate the cost effectiveness of palivizumab use in our at risk population. Methods. The study design was based on the hypothetical use of palivizumab in a cohort of patients. The cost effectiveness analysis included costs of palivizumab, the drug prescription and hospitalization. The effectiveness measure was the hospitalization rate decrease according to the result of the IMpact study: a 55% reduction in the need for hospitalization attributable to RSV. The years 1998 and 1999 were analyzed. Evaluable patients had follow-up at the High Risk Clinic and fulfilled the American Academy of Pediatrics criteria for palivizumab prophylaxis. Results. Forty-two patients, 24 with BPD and 18 preterm infants without BPD, were evaluated. Ten patients required hospitalization because of respiratory syncytial virus; one of them died. Hospitalization cost was

RESPIRATORY SYNCYTIAL VIRUS PROPHYLAXIS IN A HIGH-RISK POPULATION IN ARGENTINA : A COST-EFFECTIVENESS ANALYSIS

184 777. The total palivizumab administration cost would have been

Impacto de un programa de prevención de infecciones respiratorias en lactantes prematuros de alto riesgo: estudio prospectivo y multicéntrico

185 064. With a 55% decrease of hospitalization rate, the cost per hospitalization averted would have been

Neonatal respiratory care and infant mortality in emerging countries.

15 358, and the number needed to treat would have been 7.9. A sensitivity analysis showed that the cost per hospitalization averted could range between

Segundo Consenso Clínico de la Sociedad Iberoamericana de Neonatología: manejo hemodinámico del recién nacido

2171 and

Lack of relationship between the true airway pressure and the pressure displayed with an infant ventilator

48 630 according to the hospitalization rate. Conclusions. Because new effective but expensive treatments like palivizumab are available, this cost effective analysis can be an important tool in decisions about resource distribution.

Accesibilidad a una Unidad de Cuidados Intensivos Neonatales de alta complejidad en la Argentina

Palivizumab has proved effective in reducing hospitalization rates because of respiratory syncytial virus in vulnerable groups. In Argentina its administration is not universal because of high costs. We made a cohort study and enrolled 159 children who met the American Academy of Pediatrics recommendations but did not receive palivizumab; 26% required hospitalization for respiratory syncytial virus infection. Siblings and bronchopulmonary dysplasia were associated with higher hospitalization. For high-risk patients, one averted hospitalization was associated with costs of U.S. dollars (USD)13, 198 [number needed to treat (NNT): 4.5].

Internação devido a infecção pelo vírus sincicial respiratório em pacientes menores de 2 anos com doença cardíaca congênita hemodinamicamente significativa

UNLABELLED Respiratory tract infections (RTI), especially those caused by Respiratory Syncytial Virus (RSV), are of central concern in high-risk preterm infant care. Prevention programs including new and costly interventions should be evaluated in terms of effectiveness and impact. OBJECTIVES To evaluate feasibility and results of a National Health Ministry pilot program for severe RTI prevention in high-risk infants. METHODS Seven high-risk follow-up clinics from the public healthcare system were selected for a prospective, multicentric study. Between May and September 2007, a pilot program comprising healthcare team training, parental education, RSV passive immunoprophylaxis, RTI patient care end results evaluation was implemented. Indicators were used to evaluate feasibility; effectiveness was estimated comparing study results with two historical controls. RESULTS 183 infants were incorporated, 5 were lost and 1 died from cardiac disease. A RTI management guideline was elaborated among participating centers; parents assisted to educational workshops; palivizumab was given to participating infants up to three doses. RTI hospital admission rate for the study group was 20% (7% RSV-related), compared to 42% (26% RSV-related) and 37% (29% RSV-related) in control groups (p< 0.0001 and p= 0.02, respectively). CONCLUSIONS Program implementation was feasible and readily accepted by healthcare teams. RTI hospital admissions rates, in general and RSV-related, were significatively lower than local previous studies.

[Late diagnosis bilateral congenital diaphragmatic hernia: a case report].

This paper comments on some of the issues surrounding the implementation of organized respiratory care for newborns with lung disease in developing countries based on the studies by Z. A. Bhutta et al. and D. E. Costa et al. These studies will probably raise many different and even contradictory thoughts among readers in both industrialized and emerging areas of the world mainly in the Latin America. The very high mortality rate in emerging countries is related to a myriad of factors and is associated with issues which are difficult to solve in the short term. These include high birth rates high rates of low-birth-weight babies inadequate prenatal care high rates of low-birth-weight babies inadequate prenatal care poverty and socioeconomic and cultural issues. The work presented by Bhutta et al. and Costa et al. are examples of how care can be improved within health care institutions in developing countries. However making improvements in neonatal respiratory care is an effective way to reduce infant mortality in emerging nations and requires organization education and rationing of resources.

Infección por virus sincicial respiratorio en poblaciones vulnerables: riesgo biológico contra riesgo social

This study reports on the process and results of the Second Clinical Consensus of the Ibero-American Society of Neonatology. Eighty neonatologists from 23 countries were invited to collaborate and participate in the event. Several questions of clinical-physiological importance in the hemodynamic management of newborns were addressed. Participants were divided into groups to facilitate interaction and teamwork, with instructions to respond to three to five questions by analyzing the literature and local factors. Meeting in Mar del Plata, Argentina, the Consensus Group served as a form for various presentations and discussions. In all, 54 neonatologists from 21 countries attended, with the objective of reaching a consensus on such matters as concepts and definitions of hemodynamic instability, the physiopathology of hemodynamic compromise, recommended therapy strategies, and hemodynamic monitoring. It is hoped that this international experience will serve as a useful initiative for future consensus building and reduction of the existing disparities among the countries of the Region in terms of treatment and outcomes.