by Susanne Tropez-Sims, M.D.
“The Lives of Black Infants Matter!” the National Medical Association declared in a recent email update to members and colleagues. The statement referenced 2014 American Academy of Pediatrics guidelines, which limit preventative treatment against deadly respiratory syncytial virus (RSV) to only premature infants born before 29 weeks. Because black babies are more likely than white babies to face RSV risk factors, the AAP’s restrictions disproportionately affect them.
I applaud the NMA’s stance. It’s time that both black health care providers and their non-black colleagues demand better protection for this vulnerable population.
Which Infants are More Vulnerable to RSV?
RSV, with cold-like symptoms that can develop into serious breathing complications, bronchiolitis and wheezing, isn’t uncommon. But premature infants’ lungs and immune systems aren’t always equipped to fight it off. So for these fragile babies, symptoms may warrant hospitalization and ventilator support. Not all of them survive. In fact, RSV causes 90,000 hospitalizations and 4,500 deaths per year in children 5 years of age and younger. It’s 10 times more deadly than the flu.
No vaccine exists, but preventative treatment called “palivizumab” can help. For years, pediatric care providers have used palivizumab at their discretion to treat premature infants born before 37 weeks gestation.
Now, however, the AAP’s revised guidelines tie providers’ hands by limiting palivizumab access to only preterm infants born before 29 weeks. Insurance companies across the country have adopted these guidelines, pricing families out of RSV protection by eliminating reimbursement for treatment.
This policy shuts out the majority of preterm babies born in the United States every year. But it affects black babies in particular. Black babies are more likely than white babies to be born prematurely. And they are more likely to encounter the risk factors associated with RSV, such as low rates of breastfeeding, crowded living conditions, and contact with school-aged siblings and environmental pollutants.
Without access to preventative RSV treatment, black babies face these risks unprotected. As a result, too many will also face RSV.
To address the impending risks faced by black babies, the NMA held a landmark consensus panel on RSV. The panel included the nation’s leading experts on pediatric care, particularly among African Americans. And it summarized its findings in a peer-reviewed consensus panel report, which advocated several responses to AAP’s restrictive guidelines. Its priority recommendations includes calling for the AAP’s Committee on Infectious Diseases (COID) to provide data supporting the dosing it now recommends.
In addition, the report calls for the Centers for Disease Control to make RSV a reportable disease. Better reporting could offer more accurate data on the incidence of RSV and the demographics of the patients it affects.
The NMA has also endorsed alternative guidelines issued by the National Perinatal Association. This organization’s members stand by the Food and Drug Administration’s approved use of palivizumab for infants 36 weeks gestation and younger. Broader access would allow health care providers once again to recommend palivizumab on a patient-by-patient basis.
I urge the AAP COID to take NPA’s guidelines and NMA’s recommendations to heart. RSV season began in November for many regions of the country, and several states have already reported higher than usual rates of RSV. The lives of black babies – the lives of all babies – must be protected.
Susanne Tropez-Sims, MD is a practicing pediatrician in Nashville, Tenn. She is former chair of the National Medication Association’s Pediatric Section and a member of the Alliance for Patient Access.