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首页> 外文期刊>BMC Pediatrics >Frequency of apnea, bradycardia, and desaturations following first diphtheria-tetanus-pertussis-inactivated polio-Haemophilus influenzae type B immunization in hospitalized preterm infants
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Frequency of apnea, bradycardia, and desaturations following first diphtheria-tetanus-pertussis-inactivated polio-Haemophilus influenzae type B immunization in hospitalized preterm infants

机译：住院早产儿第一次白喉破伤风-百日咳灭活小儿麻痹症-流感嗜血杆菌免疫后呼吸暂停，心动过缓和去饱和的频率

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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.
机译：背景技术早产儿经首次白喉-破伤风-百日咳灭活的脊髓灰质炎-流感嗜血杆菌B型（DTP-IPV-Hib）免疫后，已描述了包括呼吸暂停，心动过缓和去饱和在内的不良心肺事件。最近用无细胞百日咳疫苗代替全细胞百日咳疫苗对这些事件发生频率的影响尚待进一步研究。方法1996年1月1日至2000年11月30日在两个埃德蒙顿新生儿重症监护病房出院前接受了DTP-IPV-Hib初次免疫的胎龄≤32周的婴儿符合研究条件。每个免疫婴儿的胎龄与一个对照婴儿相匹配。在免疫前（免疫后）和出生后72小时内或在同一出生后年龄中，呼吸暂停，心动过缓和/或脱饱和（ABD）的发作次数以及这些发作所需的治疗用于对照）。结果纳入研究的DTP-IPV-Hib全细胞百日咳疫苗的婴儿34例，无细胞百日咳疫苗的DTP-IPV-Hib疫苗的90例，对照组为124例。 56例免疫婴儿（45.1％）和36例对照婴儿（29.0％）在免疫后72小时内以及在出生后相同年龄的对照组中，免疫接种婴儿的ABD复发或升高，且校正后的机率与对照婴儿相比，免疫婴儿的比例为2.41（95％CI 1.29,4.51）。接受全细胞或无细胞百日咳疫苗的婴儿免疫后不良心肺事件增加的发生率相同（44.1％对45.6％）。在免疫后72小时或在对照组中，与对照组相比，免疫后的18名婴儿（14.5％）和51名对照婴儿（41.1％）的ABD降低，比值比为0.175（95％CI 0.08，0.39）。经免疫处理的婴儿对ABD的治疗需求与对照婴儿在统计学上没有差异。免疫时体重减轻是免疫后ABD复活或增加的危险因素。出生体重，胎龄，产后年龄或性别不是危险因素。结论早产儿首次服用DTP-IPV-Hib后不良心肺事件增加。较低的当前体重被确定为危险因素，全细胞与无细胞百日咳疫苗的风险相当。尽管大多数此类事件在临床上意义不大，但应在免疫后72小时内考虑对足够早产以至于在出院前接受首次免疫的婴儿进行心肺监护。

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