Whereas we the undersigned generally support and respect the American Academy of Pediatrics (AAP) and its recommendations, we are very concerned and strongly disagree with the AAP 2009 Red Book RSV guidelines that, if adopted, would restrict access of 32- to 35-week gestational age (GA) infants to RSV-related care. Nationally, these recommendations may adversely affect up to 145,000 vulnerable preterm infants each year as they may place preterm infants at a significantly increased risk for RSV-related hospitalizations. If your health plan adopts these guidelines as policy, your organization may limit access to appropriate medical care for 32-35 week GA infants born between May and July who would no longer qualify under these new recommendations. Additionally, according to these guidelines, those 32-35 week GA infants born between August and November would not receive access to appropriate medical care after they reach 90 days of age, leaving them exposed to the risk of contracting this easily spread virus during the peak of the RSV season. We further urge you to consider that 32- to 35-week GA infants with other evidence-based risk factors such as daycare attendance, presence of siblings in the household, exposure to tobacco smoke, and crowded living conditions are still at risk for severe RSV disease. Not only do these guidelines place infants at risk, they place healthcare providers in a challenging predicament because recommending practitioners deviate from clinical evidence and pivotal trial data, as well as a standard care that has existed for more than ten years. We firmly believe in the importance of using clinical evidence to make sound medical decisions. The AAP 2009 Red Book RSV guidelines do not reference the data that were used to develop these recommendations. As advocates for this vulnerable population, we strive for optimal care and services for those in need and though we typically endorse the AAPâ