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Considering the RSV shot - Page 2

post #21 of 50
I really wish my son would have qualified for the RSV shots. He is completely unvaxed, but I would have gotten them (he was a 36 weeker, born in September). He got it at around 13 weeks old, and it was miserable. He wasn't hospitalized, but it was a close one for us.

ETA: I would especially have wanted to do it if my guy had been startng daycare right at the begining of RSV season.
post #22 of 50
I was unsure if we were going to get the RSV shots. the doctor in the NICU said a child has to have at least 1 of 3 things to qualify for them... 1 .. be preemie... 2 have school age siblings 3 have parents that smoke.....

Hayden qualifies due to being preemie and having school age sibling... each shot is around 1200 dollars. according to the NICU doctor we had in Louisville.


We are definitely going to get them because my husbands niece got RSV when she was little and still gets broncitis each RSV season... not that i allow her to be around the baby at all even if she's got a sniffle but i'd rather be safe than have little man end up back in the hospital.
post #23 of 50
What is the gestational age cutoff? Audrey was 34wks, and I really am dreading winter! Ciara has rsv when she was 11mo right at Christmas and it was awful. She wasn't hospitalized for it, but it was miserable nonetheless.
post #24 of 50
Quote:
Originally Posted by mommy2maya View Post
What is the gestational age cutoff? Audrey was 34wks, and I really am dreading winter! Ciara has rsv when she was 11mo right at Christmas and it was awful. She wasn't hospitalized for it, but it was miserable nonetheless.
Typically it's 35wks or earlier.
post #25 of 50
Quote:
Originally Posted by polishprinsezz View Post
do you breastfeed? my breastfed daughter had it at 3 months but didnt get hospitalized. my cousins baby who was 6 weeks older also had it at the same time. he was formula fed and had to stay in the hospital a week. breastfeeding does help lesson the severity but i would consider the shot for this season if baby is a preemie going into daycare and isnt drinking breastmilk full time.
I was under the impression that breastmilk wasn't a factor in lessening the severity or keeping RSV from being contracted since it's a virus. (?)

I think that 35 weeks is ridiculous for insurance companies to make the cutoff. I don't know what I think it should be, probably at least 37w since that is the cutoff for preterm, but they'd save themselves a lot of money since their negotiated rate is probably nowhere near the $1200 the shots cost.

Our 11 day stay in the NICU for RSV totaled over $110k and that didn't include the $30k life flight to the hospital or the initial ER visit.

And our baby was FT, not in daycare and didn't have any school-age siblings. Imagine that. He was even born at home and had never left the house. Makes you figure the risks are so much greater when you add just one of the criteria for being eligible for the shot.
post #26 of 50
I think the cut offs are different for different insurance companies and also different from state to state. I know in my state the medicaid cut off is below 32 weeks unless there is another issue with their lungs or heart. My 34 weeker did not get the shots(he is 2 now he never got RSV but stayed incredibly sick his whole 1st full winter with pnuemonia and ear infections). My 31 and 5 day preemie who was born this past May should be eligible.
post #27 of 50
Quote:
Originally Posted by janasmama View Post
I was under the impression that breastmilk wasn't a factor in lessening the severity or keeping RSV from being contracted since it's a virus. (?)
http://www.ncbi.nlm.nih.gov/pubmed/953560?dopt=Citation
It's kind of an old study, and I'd love to find a newer one, but this is a start.
post #28 of 50
I definitely would not turn it down, my little guy had them.
post #29 of 50
Popping in to say that we just got an ex 36 weeker, now 4 weeks old, with RSV who is on a ventilator.

The dreaded RSV season has started already!!!Nooooooooo! (it's >100 degrees where we are, bleh)
post #30 of 50
We start the RSV shots next month, The pharmacy called yesterday to get it all set up. He was telling me Hayden will get shots once a month from October-April.
post #31 of 50
Audrey is in preapproval right now for them. The nurse said she should be approved.
post #32 of 50
DS was a 33 weeker, and he got the shots. I did my research and didn't think twice about doing it.

One thing to know is that this is an extremely painful injection. DS usually didn't act "right" until about day 3 after the injection. This was one of the few times we used Tylenol.
post #33 of 50
My twins were 30 weekers born in March 06. We passed on the shots and they have never had anything more then a runny nose while teething.
They are unvaxed too.
post #34 of 50
This will be the 4th year for my 3.5 year old to get the synagis.. Im 100% PRO synagis.. Im anti vaxing now but this is one I will not mess around with.

My son is very at risk for it for a lot of reasons. He got it last year and it was horrible. He didnt do well at all.
post #35 of 50
Sorry.. I should have read the replies before I posted..




Quote:
Originally Posted by polishprinsezz View Post
do you breastfeed? my breastfed daughter had it at 3 months but didnt get hospitalized. my cousins baby who was 6 weeks older also had it at the same time. he was formula fed and had to stay in the hospital a week. breastfeeding does help lesson the severity but i would consider the shot for this season if baby is a preemie going into daycare and isnt drinking breastmilk full time. you probably wont have to do the shot next season as baby will be bigger and stronger. here's to a healthy baby all winter long!
Re the breasmilk.. My 3.5 year old mention in the prior past is still 100% breastfed and even so he got RSV .....

Quote:
Originally Posted by irangel View Post
That makes sense. Our NICU only gave Syngais to the most at risk kids in September and all others started in October. My daughter was the only one to get a September shot because she was trached and vented having significant problems. She came home in October and got her shot that month out patient.

We havent been in the NICU during RSV season but have been in the hospital during it for a few years.. Around here the chronic kids (like the trach, vented kids) get it one month earlier than the others. We have always gotten it earlier than the others too because of the trach and vent and other crap.


Last year it was pretty tough to qualify because Alo (my middle child) was 2.5 at the time.. The cutoff age is normally 2 unless there are other medical issues.. Even with him being on a ventilator, oxygen, trach, etc he still had trouble qualifying.. This year we are going to have a really tough time qualifying but we are fighting like crazy for it.
post #36 of 50
We vax, but are cautious with ones not required by our school system (flu shot, etc). However this year, I think the benefits outweight the risks. Our 6 weeks out 28 weeker will be home in a week or so and we're planning on getting him the RSV shots and are seriously considering flu vax for everyone in the house (we have three older kids too, two of whom are in school). Our pediatrician has only the mercury free flu shots. We asked.
post #37 of 50
My dd received Synagis for 2 seasons and I'd do it again for her.

She breastfed exclusively for her first 8 mos and we stayed pretty close to home during the first 2 seasons.

As far as when different NICUs start giving the Synagis shots- ours gave them a few days before they sent the babies home if it was during the season. I live in a seasonal area so the season starts at slightly different times each year. It is based on how many confirmed cases of RSV are reported to the CDC for our area.

I do know that a few states are considered to be "in season" almost all year round. Those were CA and FL when I last checked. They have a very high proportion of tourists and always seem to have a few active cases of RSV at any given moment. The babies in those states are eligible for Synagis year round (depending on the insurance co's of course).

You can check the CDC website for current RSV trends, it is organized by region, state, ect-
CDC RSV Maps
post #38 of 50

Qualifications for RSV Shots

We just talked to the doctor about the RSV shots a few days ago in fact. The nurse that will be giving Hayden the shot said the qualifying factors for a baby to get the shots are some of the following.


Factors:
1. Age
* Gestational Age/Premature birth - 35 weeks of gestation or earlier, but only with additional risk factors
* Chronologic age at the start of the RSV season
* Younger than 24 months of age - Infants born at 28 weeks of gestation or earlier may benefit from prophylaxis up to 12 months of age; infants born at 29 to 32 weeks of gestation may benefit most from prophylaxis up to 6 months of age. Children over this age may have to meet other requirements in order to receive approval.

2. Weight
* Birth weight
* Percentile on the growth chart
* Underlying conditions causing low weight

3. Health Factors
* History of severe and/or chronic recent respiratory illness - Children with chronic lung disease (CLD) who have required medical therapy for their CLD within 6 months before the anticipated RSV season
* History of recent respiratory distress
* Health conditions dependent upon respiratory therapy or medications: eg - oxygen, albuterol, steroids, trachiotomy, suction, and/or other respiratory equipment dependency
* Health conditions that show substantial risk of future respiratory distress
- Chronic lung disease (CLD)
- Pulmonary Hypertension
- Asymptomatic acyanotic congenital heart disease (CHD): eg - patent ductus arteriosus or ventricular septal defect
* Immunocompromised children - immune system deficiencies: eg - severe combined immunodeficiency or severe acquired immunodeficiency syndrome

4. Costs and Other Factors
* Risk of hospitalization cost compared to prophylaxis cost
* Underlying conditions that predispose to respiratory complications (eg, neurologic disease in very low birth weight infants, lung development)
* Number of young siblings
* Child care center attendance
* Exposure to tobacco smoke in the home
* Anticipated cardiac surgery
* Distance to and availability of hospital care for severe respiratory illness
* Fragility of the medication itself - must be used within 20 minutes of mixing, must be transported and stored under strictest conditions, availability to health care provider, etc.
* Doctor recommendation and/or Letter of Medical Necessity.

Most, if not all, insurance companies require all children that receive Synagis to have precedence of respiratory illness, risk of future distress, and respiratory therapy dependency of some kind before they will even consider the other factors. It is not enough to simply be of the right age, weight, and have a gestational period of less than 35 weeks. RSV is dangerous to all children, especially premature babies, but it seems that the insurance companies want to reserve it for those who have chronic respiratory issues and are at future risk of distress.






We start the RSV shots in October, and Hayden will get one each month until April, it's expensive and we are lucky our insurance covers it.... the letter i got from the hospital it's over $1200.00 per veil so 8400 bucks at a minimum. But it's worth it for us because my hubby's niece has had RSV many times so from now until probably late spring, she will not be allowed near the baby.

Actually probably most of this winter we will keep him away from anyone that doesn't need to be near him.

Hope this helps you determine if your lil one qualifies... lets hope the insurance companies stop being such a pain about covering these shots.

The boys get vax'ed for only things required to go to school. We did the flu shot one year and my older son got so sick, never again.
post #39 of 50
Well Its either 1,200 a month for approx 4-6 months or 1,500 - 3,000 per day for a 2 or 3 week PICU stay if the baby does get RSV... I think more insurances would pay for it rathen than wanting to rsik a larger bill.. but thats not always the case... I could give you many stories of the silly things insurances do.

FWIW You can appeal the decision if you are denied.
post #40 of 50
Quote:
Originally Posted by Khourtniey View Post
Well Its either 1,200 a month for approx 4-6 months or 1,500 - 3,000 per day for a 2 or 3 week PICU stay if the baby does get RSV... I think more insurances would pay for it rathen than wanting to rsik a larger bill.. but thats not always the case... I could give you many stories of the silly things insurances do.
I don't want to pick bones, but I found this article interesting on the subject.


RSV therapy not cost-effective for infants

Last Updated: 2004-12-13 16:24:44 -0400 (Reuters Health)

NEW YORK (Reuters Health) - Treatment with Synagis (palivizumab), a type of antibody therapy, is not a cost effective way of preventing infection with respiratory syncytial virus (RSV) in high-risk infants, according to two new reports published in the medical journal Pediatrics.

The American Academy of Pediatrics recommends Synagis for infants and young children born prematurely with at least two other risk factors and for those with congenital heart disease.

Drs. Laura E. Young and William T. Mahle, at Emory University School of Medicine in Atlanta, conducted a cost analysis to determine if the protection offered by the drug was worth the cost.

The total cost of Synagis during one RSV season was estimated to be $6,160 per child. Considering the cost of Synagis versus hospitalization, the authors estimate a net loss of more than $20 million per 5,000 patients.

"The cost of administering the (Synagis) regimen to prevent one day of hospitalization was $4,600 -- nearly three times the cost of one day in the hospital," they note.

"Given the large number of congenital heart disease patients who might be considered candidates for (anti-RSV therapy) routine use of Synagis in young children with... congenital heart disease needs to be evaluated further," Young and William advise.

Dr. Steven Wegner and colleagues at the University of North Carolina in Chapel Hill conducted a study of patients born prematurely who were enrolled in the North Carolina Medicaid program. They analyzed costs during the 2002 to 2003 RSV season for 185 infants administered Synagis and 182 who were not.

During that season, 5 patients in the Synagis group and 12 in the comparison group were hospitalized -- not much of a difference from a statistical standpoint. There were no deaths in either group.

Despite no real differences in outcome, the seasonal costs per person were much higher in the Synagis group: $5,117 versus $371 in the comparison group.

Wegner's group points out that in light of ballooning Medicaid costs, many states have resorted to cutting enrollment and eliminating services.

"When Medicaid programs are faced with decisions concerning cutting enrollment versus reducing drug use that is not cost-effective, we feel certain that the choice is obvious," they note.

SOURCE: Pediatrics, December 2004.




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