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Cardio-respiratory Events and Inflammatory Response After Primary Immunization in Preterm Infants < 32 Weeks
Wissal Ben Jmaa1, Alfredo I Hernández, Megan R Sutherland
1From the *Department of Pediatrics, Sainte-Justine University Hospital and Research Center, Université de Montréal, Montreal, QC, Canada; †Inserm U1099 LTSI and Rennes-1 University, Rennes, France; ‡Department of Physiology, Development and Neuroscience, Monash University, Australia; §Department of Pharmacy, Sainte-Justine University Hospital, Université de Montréal, Montreal, QC, Canada; and ¶CHU Rennes, Department of Pediatric, Rennes, France.
Insights
Post-immunization inflammation in preterm infants is linked to cardio-respiratory events (CREs). Ibuprofen reduced CRE variation after the first immunization, suggesting a potential intervention for infant health.
Area of Science:
- Neonatal immunology
- Pediatric pharmacology
- Cardiorespiratory physiology
Background:
- Inflammation in neonates can negatively impact respiration.
- This study investigated the relationship between inflammation following immunization and cardio-respiratory events (CREs) in preterm infants.
Purpose of the Study:
- To determine if post-immunization inflammation is associated with cardio-respiratory events (CREs) in preterm infants.
- To evaluate the effect of ibuprofen on these events.
Main Methods:
- A randomized, double-blind, placebo-controlled study was conducted on infants born before 32 weeks gestation.
- Infants received standard 2-month vaccines and were randomized to receive ibuprofen or placebo.
- C-reactive protein (CRP), prostaglandin E2 (PgE2) levels, and CREs were monitored post-immunization.
Main Results:
- Immunization increased CRP levels in both groups. The placebo group showed a non-significant increase in CREs, correlated with CRP levels.
- Ibuprofen administration did not alter CRP or PgE2 levels but significantly reduced the variation in CREs post-immunization.
- The change in CREs (ΔCRE) was significantly lower in the ibuprofen group compared to the placebo group.
Conclusions:
- The first immunization in preterm infants is associated with increased CRP.
- Ibuprofen attenuated the variation in CREs after immunization but did not impact CRP or PgE2 levels.
- Further research is needed to assess the impact of anti-inflammatory treatment on vaccine antigenicity before clinical use for reducing post-immunization CREs.
Background:
Inflammation may depress respiration in neonates. This study aimed to establish a link between postimmunization inflammation and cardio-respiratory events (CREs).
Methods:
Randomized double-blind controlled study of infants born < 32 weeks gestation receiving the 2 months vaccine, which comprised diphtheria and tetanus toxoids and acellular pertussis adsorbed combined with inactivated poliomyelitis vaccines and Haemophilus b conjugate and the pneumococcal conjugate 10-valent vaccines. Infants were randomized to ibuprofen treatment or a placebo group (n = 28/group). C-reactive protein (CRP) and prostaglandins E2 (PgE2) levels were assessed before and after immunization. CREs were recorded for 72 hours. Heart rate variability was assessed by polysomnography.
Results:
In the placebo group, immunization was associated with significantly increased CRP levels and an increase in CRE (8.6 ± 11.1 before versus 14.0 ± 12.8 after), which did not reach statistical significance (P = 0.08), and no change in PgE2. The increase in CRP was correlated with changes in CRE (r = 0.4: P < 0.05). In the ibuprofen group, immunization significantly increased CRP levels but was not associated with change in CRE (6.7 ± 7.7 before versus 6.8 ± 9.7 after) and PgE2 levels. Comparing the groups, variation in CRE (ΔCRE before versus after immunization) was significantly lower in the ibuprofen group (0.1 ± 7.9 versus 5.4 ± 10.0 ΔCRE; P < 0.05).
Conclusion:
The first immunization of infants born < 32 weeks was associated with an increase in CRP. Ibuprofen treatment significantly attenuated the variation (Δ) in CRE following first immunization in these infants but the current study could not demonstrate an impact on CRP and PgE2 levels. The impact of anti-inflammatory treatment on antigenicity must be evaluated before their clinical use aiming at reducing CRE after immunization in preterm infants.
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