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Provincial Guidelines

Indications For Use


Premature infants: Palivizumab (Synagis®) 

Seasonal administration of palivizumab should be considered for infants born at 32 weeks, 0 days or earlier gestation and who are <6 months of age at the beginning of the RSV season (i.e. must be born on or after June 1st, 2023).

Children with BPD/CLD Palivizumab (Synagis®) 

Seasonal administration of palivizumab should be considered for children <24 months of age with bronchopulmonary dysplasia (BPD) / chronic lung disease (CLD) and who have required oxygen within 6 months preceding the RSV season (i.e. June 1st - November 2023), or other pulmonary disorders requiring oxygen therapy (e.g. hypoplastic lung).


Infants with Congenital Heart Disease (CHD): Palivizumab (Synagis®) 

Palivizumab will be considered for children 12 months of age or younger at the start of the RSV season diagnosed with “hemodynamically significant” congenital heart disease (CHD).

The presence of hemodynamically significant CHD will be determined by a pediatric cardiologist. The IWK Children’s Heart Centre will be consulted prior to distribution of palivizumab for these requests.

Hemodynamically significant is defined as:

  • Children with left to right shunts who require medication 
  • Children with congenital heart disease for whom surgery is pending 
  • Children with ongoing cyanosis 

Palivizumab is not recommended for use in children with minor or hemodynamically non-significant congenital or acquired heart disease, including:

  • Small patent arterial ducts 
  • Small atrial septal defects 
  • Small ventricular septal defects (not requiring medication use and/or with no significant LA or LV dilation on echo) 
  • Those children with fully repaired congenital heart disease 

Patients given prophylaxis for cardiac indications who subsequently undergo cardiopulmonary bypass, will be given a "post pump" dose if there is ongoing risk of RSV. Patients for whom the cardiac operation results in their no longer meeting criteria  will not be given a post-pump dose.


"Other" children considered to be at high risk for complicated RSV: Palivizumab (Synagis®) 

The requesting physician and an Infectious Disease Specialist or Respirologist should supply a letter along with Nova Scotia ordering requisition to AstraZeneca Canada Inc. (AstraZeneca) providing medical justification for ordering palivizumab. 

Eligible requests will be approved by an Infectious Disease physician at the IWK Health Centre.

If physicians are unsure whether a patient is eligible, the Pediatric Infectious Diseases physician on call at the IWK Health Centre is willing to provide a consult and can be contacted at (902) 470-8888 or a fax can be sent to their attention at (902) 470-7846. Examples of children who could be considered high risk are those with severe combined immunodeficiency syndrome or severe hypotonia preventing adequate clearance of respiratory secretions or those with severe chronic lung disease not due to prematurity.