Frequency of apnea, bradycardia, and desaturations following first diphtheria-tetanus-pertussis-inactivated polio-Haemophilus influenzae type B immunization in hospitalized preterm infants

Lee, Jackie; Robinson, Joan L.; Spady, Donald W.
January 2006
BMC Pediatrics;2006, Vol. 6, p1
Academic Journal
Background: Adverse cardiorespiratory events including apnea, bradycardia, and desaturations have been described following administration of the first diphtheria-tetanus-pertussis-inactivated polio-Haemophilus influenzae type B (DTP-IPV-Hib) immunization to preterm infants. The effect of the recent substitution of acellular pertussis vaccine for whole cell pertussis vaccine on the frequency of these events requires further study. Methods: Infants with gestational age of ≤ 32 weeks who received their first DTP-IPV-Hib immunization prior to discharge from two Edmonton Neonatal Intensive Care Units January 1, 1996 to November 30, 2000 were eligible for the study. Each immunized infant was matched by gestational age to one control infant. The number of episodes of apnea, bradycardia, and/or desaturations (ABD) and the treatment required for these episodes in the 72 hours prior to and 72 hours post-immunization (for the immunized cohort) or at the same post-natal age (for controls) was recorded. Results: Thirty-four infants who received DTP-IPV-Hib with whole cell pertussis vaccine, 90 infants who received DTP-IPV-Hib with acellular pertussis vaccine, and 124 control infants were entered in the study. Fifty-six immunized infants (45.1%) and 36 control infants (29.0%) had a resurgence of or increased ABD in the 72 hours post-immunization in the immunized infants and at the same post-natal age in the controls with an adjusted odds ratio for immunized infants of 2.41 (95% CI 1.29,4.51) as compared to control infants. The incidence of an increase in adverse cardiorespiratory events post-immunization was the same in infants receiving whole cell or acellular pertussis vaccine (44.1% versus 45.6%). Eighteen immunized infants (14.5%) and 51 control infants (41.1%) had a reduction in ABD in the 72 hours post- immunization or at the equivalent postnatal age in controls for an odds ratio of 0.175 (95%CI 0.08, 0.39). The need for therapy of ABD in the immunized infants was not statistically different from the control infants. Lower weight at the time of immunization was a risk factor for a resurgence of or increased ABD post-immunization. Birth weight, gestational age, postnatal age or sex were not risk factors. Conclusion: There is an increase in adverse cardiorespiratory events following the first dose of DTP-IPV-Hib in preterm infants. Lower current weight was identified as a risk factor, with the risk being equivalent for whole cell versus acellular pertussis vaccine. Although most of these events are of limited clinical significance, cardiorespiratory monitoring of infants who are sufficiently preterm that they are receiving their first immunization prior to hospital discharge should be considered for 72 hours post-immunization.


Related Articles

  • Effect of a fourth Haemophilus influenzae type b immunisation in preterm infants who received dexamethasone for chronic lung disease. Clarke, P.; Powell, P.J.; Goldblatt, D.; Robinson, M.J. // Archives of Disease in Childhood -- Fetal & Neonatal Edition;Jan2003, Vol. 88 Issue 1, pF58 

    Aim: To assess whether a fourth Hib polysaccharide-tetanus protein conjugate vaccine (PRP-T) would improve antibody response in preterm infants previously treated with dexamethasone for chronic lung disease. Methods: In a pilot study 12 infants born at less than 30 weeks gestation who had...

  • Hib vaccination in infants born prematurely. Heath, P.T.; Booy, R.; McVernon, J.; Bowen-Morris, J.; Griffiths, H.; Slack, M.P.E.; Moloney, A.C.; Ramsay, M.E.; Moxon, E.R. // Archives of Disease in Childhood;Mar2003, Vol. 88 Issue 3, p206 

    A group of therapies with exciting potential has emerged for children and young people with severe juvenile idiopathic arthritis (JLA) uncontrolled by conventional disease modifying drugs. Theoretical understanding from molecular biologic research has identified specific targets within...

  • Apnea, bradycardia and desaturation in preterm infants before and after feeding. Slocum, C.; Arko, M.; Di Fiore, J.; Martin, R. J.; Hibbs, A. M. // Journal of Perinatology;Mar2009, Vol. 29 Issue 3, p209 

    Objective:A common clinical impression is that both gastroesophageal reflux (GER) and cardiorespiratory events increase after feeding in preterm infants. We aimed to measure objectively the effects of feeding on GER, apnea, bradycardia and desaturations.Study Design:We conducted a retrospective...

  • Randomised crossover trial of different postural interventions on bradycardia and intermittent hypoxia in preterm infants. Reher, C; Kuny, K D; Pantalitschka, T; Urschitz, M S; Poets, C F // Archives of Disease in Childhood;Jul2008 Supplement, Vol. 93 Issue 4, pF289 

    Background: Apnoea of prematurity has been shown to respond to changes in posture. Objective: To investigate the effect of three postural interventions on the rate of bradycardia and desaturation events. Methods: 18 infants (⩽ 32 weeks' gestational age; 11 boys) with apnoea of prematurity...

  • Haemophilus influenzae type B. Boiter, Cynthia // Pediatrics for Parents;1993, Vol. 14 Issue 7/8, p15 

    Discusses the disease, Haemophilus influenzae type b. Manifestations of the disease; Approval of a vaccine for use in infants; Parents' fear of possible side effects as the reason why many children are not immunized against childhood diseases; American Academy of Family Physicians' 1990...

  • Hib booster reinstated for 12 to 15 months old.  // Infectious Disease News;Jul2009, Vol. 22 Issue 7, p20 

    The article reports on the reinstated dose of Haemophilus influenzae type b vaccine for children at 12-15 months in the U.S.

  • Hib vaccination coverage often overestimated.  // Infectious Diseases in Children;Oct2010, Vol. 23 Issue 10, p27 

    The article reports on the results of the National Immunization Survey on the effects of the new coverage measures on Haemophilus influenzae type b (Hib) vaccination in the U.S.

  • Untitled.  // Archives of Disease in Childhood -- Fetal & Neonatal Edition;Sep2013, Vol. 98 Issue 5, pe1 

    A correction to the article "The impact of oral sucrose on apnea and bradycardia in preterm infants: a randomised cross-over trial" published in a 2013 issue is presented.

  • Risk of fever and sepsis evaluations after routine immunizations in the neonatal intensive care unit. Navar-Boggan, A. M.; Halsey, N. A.; Golden, W. C.; Escobar, G. J.; Massolo, M.; Klein, N. P. // Journal of Perinatology;Sep2010, Vol. 30 Issue 9, p604 

    Objective:Premature infants can experience cardiorespiratory events such as apnea after immunization in the neonatal intensive care unit (NICU). These changes in clinical status may precipitate sepsis evaluations. This study evaluated whether sepsis evaluations are increased after immunizations...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics