Incidence of apnoea and bradycardia in preterm infants following DTP_w and Hib immunization: A prospective study

Abstract

Objective: To evaluate the incidence and severity of apnoea and bradycardia in hospitalized preterm infants following immunization at 2 months of age, and identify risk factors. Methodology: A prospective study of 98 preterm infants, of gestational age 24-31 weeks, immunized at approximately 2 months post natal age with diphtheria-tetanus-whole cell pertussis vaccine (DTP,) in the neonatal intensive care unit (NICU) at King George V Hospital Sydney. Half the infants also received Haemophilus influenzae type b conjugate vaccine (Hib) simultaneously. All infants were monitored for apnoea and bradycardia in the 24 h periods pre-and post immunization. Results: Only one infant had apnoea and/or bradycardia pre-immunization compared with 17 post immunization. For 12 infants these events were brief, self-limiting and not associated with desaturations (oxygen saturation < 90Y0). However, for five infants (30%) these events were associated with oxygen desaturation and two of these infants required supplemental oxygen. The group that had apnoea and/or bradycardia and the group that did not were not significantly different in terms of gestational age, birth weight and other variables. Infants who received Hib together with DTP, were less likely to have apnoea and/or bradycardia than those given DTP, alone. Conclusion: When considering immunization for preterm infants, the benefits of early immunization must be balanced against the risk of apnoea and bradycardia. We recommend that the cardio-respiratory function of hospitalized infants born at less than 31 weeks gestation be monitored for 48 h post immunization.

Identification of suspected fatal adverse drug reactions by paediatricians: a UK surveillance study

“…Apnoea has been reported in preterm infants in the 3 days following DTP (diphtheria, tetanus and pertussis) and Hib immunisation 13 14. However, the slow deterioration was more likely to be caused by pulmonary hypertension.…”

QUESTION 2: Vaccinating preterm infants in resource-poor settings: what is the incidence of apnoea, bradycardia and need for respiratory support?

“…Of note, Botham et al 2 used the whole-cell pertussis vaccine, which is less commonly used now due to concerns about respiratory compromise in premature infants.…”

Adverse cardiorespiratory events following primary vaccination of very low birth weight infants

“…Em estudos publicados recentemente, foi usada uma vacina acelular contra coqueluche, mas também foram relatadas reações adversas semelhantes [7][8][9][10][11][12] . A taxa de reações adversas teve grande variação entre os estudos (6% a 50%) 2,[11][12][13][14][15][16][17] . Estudos sugerem que recém-nascidos de muito baixo peso (RNMBP, peso ao nascer < 1.500 g) são um grupo de pacientes particularmente vulnerável ao desenvolvimento de reações adversas graves 8,15,16 .…”