Abnormal Cardiorespiratory Responses to Immunization in Premature Infants

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http://pediatrics.aappublications.org/cgi/content/abstract/101/3/e3

PEDIATRICS Vol. 101 No. 3 March 1998, p. e3

ELECTRONIC ARTICLE:

Interleukin-6, C-Reactive Protein, and Abnormal Cardiorespiratory Responses

to Immunization in Premature Infants

Received Aug 5, 1997; accepted Nov 20, 1997.

Massroor Pourcyrous*, Dagger , §, Sheldon B. Korones*, Dagger , Dennis

Crouse*, Dagger , and Henrietta S. Bada*, Dagger

From the Departments of * Pediatrics, Dagger Obstetrics and Gynecology,

and § Physiology and Biophysics, University of Tennessee-Memphis, Memphis,

Tennessee.

Objective. We report our experience with routine immunization of 89

premature infants in the neonatal intensive care unit because 1) a

substantial number of them developed abnormal clinical signs, and 2) all

but one of those who received diphtheria, tetanus, and whole-cell pertussis

(DTwP) vaccine responded with elevations of interleukin-6 (IL-6) and

C-reactive protein (CRP) concentrations that are otherwise characteristic

of bacterial disease.

Methodology. We hypothesized that the elevated IL-6 and CRP levels were

solely a response to immunization and that treatment with antibiotics was

not necessary. We performed this study in two consecutive parts. In part 1,

we prospectively evaluated 79 consecutive premature infants who were

immunized with DTwP, Haemophilus b conjugate vaccine, hepatitis B vaccine,

and inactivated polio vaccine, (Hib, HBV, and IPV). IL-6 and CRP were

determined before immunization and every 12 hours on three occasions after

immunization. In part 2, we studied an additional 10 infants who received

acellular pertussis vaccine (DTaP) and who, 2 days later, received Hib,

HBV, and IPV immunization simultaneously. We followed the same schedule of

IL-6 and CRP determinations as in part 1.

Results. In part 1, 24 infants (30%) developed abnormal cardiorespiratory

signs within 24 hours after immunization. CRP and IL-6 values rose to

abnormal levels after immunization in all but one infant; that infant was

later shown to have a T-cell abnormality. In part 2, 3 infants had abnormal

cardiorespiratory signs after simultaneous immunization with Hib, HBV, and

IPV, but not after DTaP. IL-6 and CRP levels remained normal in all 10

infants.

Conclusions. Part 1 demonstrates clearly the temporal relationship between

IL-6 and CRP increments after DTwP, Hib, HBV, and IPV vaccines. In part 2

(DTaP was substituted for DTwP), there were no elevations of IL-6 or CRP,

thus indicating that whole-cell pertussis component of DTwP was responsible

for IL-6 and CRP elevations. Abnormal cardiorespiratory signs occurred

frequently after immunizations in part 1, but they were unrelated to the

magnitude of IL-6 and CRP elevations. The frequency of cardiorespiratory

difficulty and its occasional severity suggest a need to monitor premature

infants for ~48 hours after routine immunization.

Key words: immunization, C-reactive protein, Interleukin-6, premature,

bronchopulmonary dysplasia.

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Sheri Nakken, former R.N., MA, Hahnemannian Homeopath

Vaccination Information & Choice Network, Nevada City CA & Wales UK

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