Objective We utilized the opportunity of  highload off-season RSV admissions with no prophylaxis given during the summer of 2021, to assess the impact of withholding palivizumab on the relative burden among hospitalized 29-34 wGA infants. Methods This was a national multi-center retrospective study conducted in 11 medical centers. We included infants under 12 months who were hospitalized with RSV between November 2017-August 2021. We extracted demographics and clinical data from the medical records and categorized our cohort into an in-season admissions group (November-March) when palivizumab was indicated, and an off-season admissions group (April-October) when palivizumab was not indicated. The primary outcome was the proportion of 29-34 wGA hospitalizations in each group. Results We included 4,340 children (3,296 in-season/1,044 off-season); 57% were males, 61% were Jewish, and the median age at admission was 2.9 months (IQR 1.4-6.4). The proportion of 29-34 wGA preemies was significantly higher in the off-season group compared to the in-season group (7% vs 2.1%, p<0.001). We found a significantly higher prevalence of Jewish (77% vs 57%, p=0.001) and higher socioeconomic status (55% vs 45%, p<0.001) in the off-season compared to the in-season group. Multivariable logistic regression model revealed that the relative-odds of 29-34 wGA preemies to be hospitalized off-season was 2.67 (95%CI: 1.8-3.9, p<0.001) fold higher than in-season, independent of confounders. Conclusion We showed a significantly higher proportion of 29-34 wGA preemies among infants hospitalized during off-season periods,which may support the current broad Israeli policy for palivizumab.