ABSTRACT for Caution Needed When Immunizing Premature Infants

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" Precautionary monitoring following immunizations is warranted. "

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Sheri

Vicky Debold found the abstract - below..........

http://www.jpeds.com/article/PIIS0022347607001850/abstract?browse_volume=151

& issue_key=S0022-3476%2807%29X0112-4 & issue_preview=no & select1=no & select1=no &

vol=

Primary Immunization of Premature Infants with Gestational Age <35 Weeks:

Cardiorespiratory Complications and C-Reactive Protein Responses Associated

with Administration of Single and Multiple Separate Vaccines Simultaneously

Massroor Pourcyrous, MDabcCorresponding Author Informationemail address,

Sheldon B. Korones, MDab, Kristopher L. Arheart, PhDd, Henrietta S. Bada, MDe

Received 14 April 2006; received in revised form 29 December 2006; accepted

21 February 2007. published online 26 June 2007.

Objective

To determine the incidence of cardiorespiratory events and abnormal

C-reactive protein (CRP) level associated with administration of a single

vaccine or multiple separate vaccines simultaneously.

Study design

Prospective observational study on 239 preterm infants at e2 months of age

in the neonatal intensive care unit (NICU). Each infant received either a

single vaccine or multiple vaccines on one day. CRP levels and

cardiorespiratory manifestations were monitored for 3 days following

immunization.

Results

Abnormal elevation of CRP level occurred in 85% of infants administered

multiple vaccines and up to 70% of those given a single vaccine. Overall,

16% of infants had vaccine-associated cardiorespiratory events within 48

hours postimmunization. In logistic regression analysis, abnormal CRP

values were associated with multiple vaccines (OR, 15.77; 95% CI

5.10-48.77) and severe intraventricular hemorrhage (IVH) (OR, 2.28; 95% CI

1.02-5.13). Cardiorespiratory events were associated marginally with

receipt of multiple injections (OR, 3.62; 95% CI 0.99-13.25) and

significantly with gastroesophageal reflux (GER) (OR, 4.76; 95% CI

1.22-18.52).

Conclusion

CRP level is expected to be elevated in the 48 hours following

immunization. In a minority of infants immunized, cardiorespiratory events

were associated with presumed need for intervention. Underlying medical

conditions and possibly multiple injections are associated with

cardiorespiratory events. Precautionary monitoring following immunizations

is warranted.

Abbreviations: AAP, American Academy of Pediatrics, AOP, Apnea of

prematurity, BPD, Bronchopulmonary dysplasia, BW, Birth weight, CPAP,

Continuous positive airway pressure, CRP, C-reactive protein, DTaP,

Diphtheria-tetanus-acellular pertussis, DTwP, Diphtheria-tetanus-whole cell

pertussis, GA, Gestational age, GER, Gastroesophageal reflux, HBV,

Hepatitis B vaccine, Hib, Haemophilus influenzae type b conjugate, IPPV,

Intermittent positive pressure ventilation, IPV, Inactivated poliovirus

vaccine, IVH, Intraventricular hemorrhage, NICU, Neonatal intensive care

unit, PCV7, Pneumococcal 7-valent conjugated vaccine