Successful Implementation of Nirsevimab and Factors Influencing Uptake in Neonatal Care

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OBJECTIVE: To describe the implementation of nirsevimab for the prevention of respiratory syncytial virus-associated lower respiratory tract disease in a pediatric hospital, focusing on strategies to ensure equitable access and address logistic challenges. Additionally, we aimed to identify predictors of nirsevimab deferral among eligible infants. METHODS: Our hospital implemented a universal immunization campaign to all eligible infants, including those discharged from the newborn nursery, intermediate care nursery, and neonatal intensive care unit. We identified key drivers and barriers, formed a multidisciplinary team, and applied a systematic approach for integration of nirsevimab orders into existing workflows. We developed and disseminated educational resources for staff and caregivers. After the implementation, we conducted univariable and multivariable analyses to identify predictors of nirsevimab deferral to evaluate implementation success and possible gaps. RESULTS: Despite challenges, we offered nirsevimab to 99% of eligible infants prior to discharge from the newborn nursery, intermediate care nursery, and neonatal intensive care unit with 71% receiving the immunization. On the multivariable analysis, independent predictors of nirsevimab deferral included preferred language of English, deferral of hepatitis B vaccine, discharge from the newborn nursery, and public insurance. CONCLUSIONS: Our implementation strategy ensured equitable access to nirsevimab for newborns with both our high uptake and acceptance rate underscoring the effectiveness of our approach. Key strategies for success included early stakeholder engagement, multidisciplinary collaboration, and proactive logistic planning. Our approach serves as a model for other institutions to offer nirsevimab prior to hospital discharge and highlights the importance of addressing both clinical and socioeconomic barriers.

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