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Cardiorespiratory Events Following the Second Routine Immunization in Preterm Infants: Risk Assessment and Monitoring
Bettina Bohnhorst1, Cornelia Weidlich1, Corinna Peter1
1Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, 30625 Hannover, Lower Saxony, Germany.
Insights
Extremely preterm infants often experience cardiorespiratory events (CREs) after routine immunizations (rIM). Monitoring is recommended after the second rIM, especially for infants with prior CREs, until 44 weeks postmenstruation.
Area of Science:
- Neonatology
- Pediatric Cardiology
- Immunology
Background:
- Current guidelines suggest monitoring extremely preterm infants after the second routine immunization (rIM) due to frequent cardiorespiratory events (CREs) post-first rIM.
- Evidence regarding CREs after the second rIM is limited, necessitating further investigation.
Purpose of the Study:
- To prospectively monitor cardiorespiratory events (CREs) in extremely preterm infants before and after their second routine immunization (rIM).
- To identify risk factors for CREs and determine the appropriate monitoring duration post-second rIM.
Main Methods:
- A prospective observational study involving 71 extremely preterm infants (median gestational age 26.4 weeks).
- Infants with increased CREs after the first rIM were monitored for CREs before and after the second rIM.
- Data collected included gestational age, weight, postnatal age, and respiratory support needs.
Main Results:
- A significant increase in hypoxemias, apneas, and cardiorespiratory events requiring tactile stimulation (CRE-ts) was observed after the second rIM (p < 0.0001, p = 0.0003, p = 0.0034 respectively).
- Infants with CRE-ts were more likely to have continuous hospitalization, receive analeptic therapy, or require respiratory support.
- CRE-ts resolved by a postmenstrual age of 43.5 weeks.
Conclusions:
- The study supports current recommendations for monitoring extremely preterm infants for CREs during and after the second rIM.
- Monitoring should continue up to a postmenstrual age of 44 weeks for infants exhibiting specific risk factors.
- These findings enhance understanding of cardiorespiratory event patterns in preterm infants following immunization.
Abstract:
Due to frequent cardiorespiratory events (CREs) in response to the first routine immunization (rIM), current guidelines recommend readmitting and monitoring extremely preterm infants after the second rIM, though evidence on CREs in response to the second rIM is weak. In a prospective observational study, preterm infants with an increase in CREs after the first rIM were monitored for CREs before and after the second rIM. Seventy-one infants with a median gestational age of 26.4 weeks and a median weight of 820 g at birth were investigated at a median postnatal age of 94 days. All but seven infants showed an increase in CREs after the second rIM. The frequency of hypoxemias (p < 0.0001), apneas (p = 0.0003) and cardiorespiratory events requiring tactile stimulation (CRE-ts) (p = 0.0034) increased significantly. The 25 infants (35%) presenting with CRE-ts were significantly more likely to have been continuously hospitalized since birth (p = 0.001) and to receive analeptic therapy at the first rIM (p = 0.002) or some kind of respiratory support at the first (p = 0.005) and second rIM (p < 0.0001). At a postmenstruational age of 43.5 weeks, CRE-ts ceased. Our data support the recommendation to monitor infants who fulfil the above-mentioned criteria during the second rIM up to a postmenstruational age of 44 weeks.
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