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Apnea after immunization of preterm infants
P J Sánchez1, A R Laptook, L Fisher
1Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, USA.
Insights
Vaccinations with diphtheria, tetanus, pertussis, and HibC vaccines may cause temporary apnea recurrence in preterm infants. Monitoring cardiorespiratory status post-immunization is recommended for vulnerable infants.
Area of Science:
- Neonatal Medicine
- Pediatric Immunology
- Vaccinology
Background:
- Preterm infants may experience apnea of prematurity.
- Routine immunizations are critical for infant health.
- Assessing vaccine safety in vulnerable populations is essential.
Purpose of the Study:
- To evaluate adverse reactions, specifically apnea, in preterm infants post-immunization.
- To determine the frequency of apnea recurrence after DTP and HibC vaccination.
Main Methods:
- Prospective surveillance of 97 preterm infants (gestational age < 37 weeks) in the NICU.
- Data collected for 72 hours before and after DTP and Haemophilus influenzae type b conjugate (HibC) vaccination.
- Focused assessment on apnea and bradycardic episodes.
Main Results:
- 12% of preterm infants had apnea recurrence; 11% had a significant increase in apneic/bradycardic episodes.
- Adverse events were more common in smaller infants, those immunized at lower weights, with severe apnea, or chronic lung disease.
- Most infants tolerated DTP and HibC vaccines without significant issues.
Conclusions:
- A temporal association exists between DTP/HibC immunization and transient apnea increase in preterm infants.
- Further research is warranted to understand this association.
- Cardiorespiratory monitoring post-vaccination may be advisable for at-risk preterm infants.
Objective:
To determine the frequency of adverse reactions, particularly the occurrence of apnea, among preterm infants after immunization with diphtheria and tetanus toxoids and whole cell pertussis vaccine adsorbed (DTP) and Haemophilus influenzae type b conjugate (HibC) vaccine in the neonatal intensive care unit.
Study Design:
After the occurrence of apnea in two preterm infants following immunization with DTP and HibC, a prospective surveillance of 97 preterm infants younger than 37 weeks of gestation who were immunized with DTP (94 also received HibC at the same time) in the neonatal intensive care unit was performed to assess the frequency of adverse reactions and in particular, the occurrence of apnea. For each infant, data were recorded for a 3-day period before and after receipt of the immunization.
Results:
The majority of preterm infants tolerated immunizations with DTP and HibC without ill effects. However, 12 (12%) infants experienced a recurrence of apnea, and 11 (11%) had at least a 50% increase in the number of apneic and bradycardic episodes in the 72 hours after immunization. This occurred primarily among smaller preterm infants who were immunized at a lower weight (p = 0.01), had experienced more severe apnea of prematurity (p = 0.01), and had chronic lung disease (p = 0.03).
Conclusion:
The temporal association observed between immunization of preterm infants and a transient increase or recurrence of apnea after vaccination merits further study. Cardiorespiratory monitoring of these infants after immunization may be advisable.