Young children 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 palivizumab for cardiac indications who subsequently undergo cardiopulmonary bypass, will be given a "post pump" dose if they have ongoing risk factors. Patients for whom the cardiac operation results in their no longer meeting criteria for palivizumab will not be given a post-pump dose. All patients started on a course of palivizumab will still complete the full course (5-6 doses) for that season, regardless of the type of repair they have.