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Increased risk for bronchitis after discharge in non-vaccinated very low birth weight infants
G Stichtenoth1, C Härtel1, J Spiegler1
1Department of Pediatrics, University Hospital of Schleswig-Holstein, Lübeck, Germany.
Insights
Vaccinating very low birth weight (VLBW) infants may reduce hospital readmissions for bronchitis. Standard vaccination and RSV immunoprophylaxis show protective effects against infant bronchitis.
Area of Science:
- Pediatrics
- Neonatology
- Infectious Disease Prevention
Background:
- Obstructive bronchitis is a common cause of hospital re-admission in very low birth weight (VLBW) infants.
- Early vaccinations are recommended for VLBW infants starting at 2 months post-birth.
Purpose of the Study:
- To identify risk factors for bronchitis in VLBW infants within the first year post-discharge.
- To evaluate the impact of in-hospital standard vaccinations and palivizumab (RSV immunoprophylaxis) on bronchitis rates.
Main Methods:
- A questionnaire surveyed parents of 1,967 VLBW infants (born 2009-2011) regarding bronchitis episodes.
- Bronchitis occurrences were correlated with clinical parameters and risk factors.
- Vaccination effects were assessed in infants discharged after day 60.
Main Results:
- Male gender and older siblings were identified as risk factors for bronchitis.
- 24% of VLBW infants experienced bronchitis.
- In infants discharged after day 60, bronchitis rates were 31% in unvaccinated vs. 17% with palivizumab±standard vaccination (p=0.003) and 20% with standard vaccination alone (p=0.037).
Conclusions:
- Non-vaccinated male VLBW infants with older siblings face higher bronchitis risk post-discharge.
- Scheduled vaccinations appear protective against bronchitis, though mechanisms require further study.
- Increasing timely vaccination rates in preterm infants is crucial.
Background:
In very low birth weight (VLBW) infants, obstructive bronchitis is a frequent cause of hospital re-admission. For VLBW infants, early vaccinations starting at 2 months after birth have been recommended.
Objective:
To analyze risk factors for bronchitis during the first year after discharge and the effects of in-hospital standard vaccination (hexavalent/pneumococci) and/or RSV immunoprophylaxis with palivizumab.
Methods:
A standardized questionnaire was sent to the parents of VLBW infants 7 month after discharge. The reported episodes of bronchitis were correlated with clinically recorded parameters including risk factors for pulmonary morbidity. The effects of in-hospital vaccination were assessed in a subgroup discharged after day 60.
Results:
A sample of 1 967 responses of infants born 2009-2011 was analyzed. Risk factors for bronchitis were male gender and older siblings. 24% of the population had episodes of bronchitis. In the subgroup discharged after day 60, episodes of bronchitis were reported for 31% of infants who were not vaccinated in-hospital. A significant reduction of the bronchitis rate was found in infants who received palivizumab±standard vaccination (17% bronchitis, p=0.003). Interestingly, in-hospital standard vaccination without RSV immunoprophylaxis was protective (20% bronchitis; p=0.037) as well.
Conclusions:
Non-vaccinated male VLBW infants with older siblings are at increased risk for bronchitis during the first year after discharge. Vaccination according to schedule seems to have protective effects, while underlying mechanisms are unknown. The rate of timely vaccination in preterm infants should be increased.
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