Apnea after immunization of preterm infants*
Section snippets
METHODS
The study population for the prospective evaluation of the potential adverse effects of immunization on preterm infants consisted of 101 consecutive premature infants younger than 37 weeks of gestation who received an intramuscular injection of DTP vaccine (0.5 ml, Lederle Laboratories) in the NICU at Parkland Memorial Hospital during a 17-month period (Nov. 14, 1991, through April 21, 1993).
Four of the 101 infants were excluded from the study analysis. One had CLD and oxygen requirement at 58
Patient characteristics
The study population consisted of 97 infants; there were 50 girls and 47 boys. The mean birth weight was 991 ± 296 gm (range 460 to 2620 gm) and mean gestational age was 28 ± 2 weeks (range 24 to 34 weeks). Median Apgar scores were 4 and 7 at 1 and 5 minutes, respectively. The majority of the subjects were black (47%) and Latin-American infants (33%).
The majority (62/97, 64%) of infants had hyaline membrane disease; in 41 (42%) CLD developed. Ninety-three (96%) infants had experienced apnea of
DISCUSSION
In this prospective evaluation, we found that there was a transient recurrence (12%) or increase in apneic episodes (11%) observed in immunized preterm infants that coincided with the administration of DTP immunization. Because systemic and local reactions are significantly more frequent after immunization with DTP than after diphtheria and tetanus toxoids vaccine (adsorbed) alone,8, 9 it could be postulated that the apnea is related to the pertussis component of the vaccine, but this is an
Acknowledgements
We thank Maria Paris, MD, for assistance in performing the statistical analyses; Fiker Zeray, RN, and N. Kristine Leos, BS, for assistance in data collection and entry; and John D. Nelson, MD, for review of the manuscript.
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Cited by (65)
A successful preterm vaccination program in a neonatal unit in a developing country
2019, HeliyonCitation Excerpt :It was reassuring that no side effects were reported. Apnoea has previously been associated with the use of vaccines in preterm infants [12], but this was thought to be associated with the whole cell pertussis vaccine [13]. South Africa changed to the acellular pertussis vaccine in 2009, which has been shown to not increase apnoeic events compared to control [14].
Clinical and experimental aspects of breathing modulation by inflammation
2019, Autonomic Neuroscience: Basic and ClinicalCitation Excerpt :It is generally recognized that patients with chronic bronchial asthma have a depressed hypoxic ventilatory response that may contribute to respiratory failure (Hudgel and Weil, 1975; Chang et al., 1978; Hida, 1999; Hudgel and Weil, 1975; Hutchison and Olinsky, 1981; Kikuchi et al., 1994; Smith and Hudgel, 1980; Town and Allan, 1989) which has been associated with diminished hypoxic perception (Kikuchi et al., 1994). Immunization has also been related to respiratory dysfunctions, including an increased occurrence of cardiorespiratory events (Ben Jmaa et al., 2017) that are associated with single or recurrent apneas and are predominant in preterm infants (Clifford et al., 2011; Botham and Isaacs, 1994; Botham et al., 1997; Cooper et al., 2008; Faldella et al., 2007; Lee et al., 2006; Pfister et al., 2004; Sánchez et al., 1997; Slack and Schapira, 1999; Furck et al., 2010; Flatz-Jequier et al., 2008). Preterm infants experience either an increase in or a resurgence of apnea after vaccination (Botham and Isaacs, 1994; Botham et al., 1997; Pfister et al., 2004; Sánchez et al., 1997; Sen et al., 2001; Slack and Schapira, 1999; Slack et al., 2003), with major cardiorespiratory events after vaccination occurring more often in very low birth weight infants (Meinus et al., 2012) and in patients with preexisting cardiorespiratory events (Pfister et al., 2004; Faldella et al., 2007).
General Immunization Practices
2017, Plotkin's VaccinesGeneral immunization practices
2012, Vaccines: Sixth EditionRecurrent apnoea post immunisation: Informing re-immunisation policy
2011, VaccineCitation Excerpt :Immunisation schedules around the world recommend that preterm infants should receive immunisations according to their chronological age, in order to prevent the serious adverse consequences of the infections against which vaccines protect [1]. It is known that a number of preterm infants, particularly those with very low birth weight, may have an apnoea (with or without accompanying bradycardia) as an adverse event following immunisation (AEFI) [2–11]. In some neonatal nurseries the incidence of apnoea has been reported between 10 and 20% in the first 24 h following preterm infants’ two-month immunisations [3,7], although a randomized multi-centre study found the apnoeic events were occurring sporadically and were not necessarily causally associated with immunisation [12].
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Presented in part at the 33rd Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC), New Orleans, La., Oct. 17–20, 1993.