OBJECTIVES: Respiratory Syncytial virus (RSV) is the leading cause of respiratory tract infections. Efficacy of Palivizumab in reducing RSV related hospitalizations has been proven in preterm born infants and children with congenital heart disease (CHD) or bronchopulmonary dysplasia (BPD). However, the high costs of Palivizumab may limit its use. This study  described the characteristics of Palivizumab users in the Netherlands and assessed the determinants of receiving Palivizumab among infants with an indication according to the label. METHODS: Data for this study were obtained by linking the PHARMO database network, which includes detailed information on drug dispensing and hospitalization histories, and The Netherlands Perinatal Registry, including perinatal medical case records. From this linked cohort, all infants born between April 1, 1999 and March 31, 2007 were selected and characteristics of those receiving Palivizumab were described. Among infants with an indication to receive Palivizumab (i.e. born <35 weeks, CHD or BPD), recipients were compared with non-recipients and determinants of receiving Palivizumab were examined using logistic regression analyses. RESULTS: Among the 3321 infants with an indication to receive Palivizumab, only 15% were recipients. The majority was born <32 weeks of gestation and mean age at first use was 3.1 months. The strongest predictor of receiving Palivizumab was being born <32 weeks (OR 49.1; 95%CI 31.5-76.4). However, among the infants born <32 weeks, still 50% did not receive Palivuzmab. Subanalyses among this group showed that the likelihood of receiving Palivizumab was higher for infants born in later years, having respiratory distress syndrome or being hospitalized in  the RSV season. CONCLUSIONS: In the Netherlands, Palivizumab is mostly prescribed to infants born <32 weeks, which is according to Dutch guidelines. Use has increased over the years. However, not all children addressed in the label indication are receiving Palivizumab.