Use of nirsevimab in extremely preterm infants: position of the Neonatal Infections Committee of the Chilean Society of Infectious Diseases

Abstract

Preterm infants, particularly those who are extremely preterm or weigh less than 1,000 g at birth, are at the highest risk of severe respiratory infection caused by respiratory syncytial virus (RSV). While nirsevimab has demonstrated significant efficacy in preventing severe RSV disease, preliminary evidence regarding its use in hospitalized preterm infants during the neonatal period was limited. National experience from two consecutive RSV seasons indicates that early in-hospital administration of nirsevimab in clinically stable preterm infants is a safe, feasible, and well-tolerated strategy, with no serious adverse events linked to the drug, even among extremely low birth weight neonates. It likewise reduces the period of vulnerability prior to hospital discharge and ensures protection during phases of community circulation or risk of nosocomial transmission. Based on the available evidence and considering the national epidemiological situation, the Neonatal Infections Committee of the Chilean Society of Infectious Diseases believes that early in-hospital immunization with nirsevimab should be promoted in clinically stable preterm infants, accompanied by cardiorespiratory monitoring in the highest-risk groups.