Premature infants can experience cardiorespiratory events such as apnea after immunization in the neonatal intensive care unit (NICU). These changes in clinical status may precipitate sepsis evaluations. This study evaluated whether sepsis evaluations are increased after immunizations in the NICU.
We conducted a retrospective cohort study of infants older than 53 days who were vaccinated in the NICU at the KPMCP (Kaiser Permanente Medical Care Program). Chart reviews were carried out before and after all immunizations were administered and for all sepsis evaluations after age 53 days. The clinical characteristics of infants on the day before receiving a sepsis evaluation were compared between children undergoing post-immunization sepsis evaluations and children undergoing sepsis evaluation at other times. The incidence rate of sepsis evaluations in the post-immunization period was compared with the rate in a control time period not following immunization using Poisson regression.
A total of 490 infants met the inclusion criteria. The rate of fever was increased in the 24 h period after vaccination (2.3%, P<0.05). The incidence rate of sepsis evaluations was 40% lower after immunization than during the control period, although this was not statistically significant (P=0.09). Infants undergoing a sepsis evaluation after immunization were more likely to have an apneic, bradycardic or moderate-to-severe cardiorespiratory event in the day before the evaluation than were infants undergoing sepsis evaluations at other times (P<0.05).
Despite an increase in fever and cardiorespiratory events after immunization in the NICU, routine vaccination was not associated with increased risk of receiving sepsis evaluations. Providers may be deferring immunizations until infants are clinically stable, or may have a higher threshold for initiating sepsis evaluations after immunization than at other times.
"Maternal infection and this resulting inflammatory response are significant risk factors for central nervous system damage in premature newborns (Grether and Nelson, 1997; Wu and Colford, 2000; Grether et al., 2003; Nelson 2009) as well as fullterm infants (Wu et al., 2003). Breathing pattern abnormalities ranging from tachypnea to apnea of prematurity are prominent initial manifestations of sepsis—which is whole body, systemic inflammation in response to infection—and may contribute to morbidity in this high risk population (Darnall et al., 1997; Fanaroff et al., 1998; Navar-Boggan et al., 2010). "
[Show abstract][Hide abstract] ABSTRACT: In infants, respiratory infection elicits tachypnea. To begin to evaluate the role of brainstem cytokine expression in modulation of breathing pattern changes, we compared the pattern generated after endotracheal instillation of lipopolysaccharide (LPS) in in vivo rat pups to local pro-inflammatory cytokine injection in the nucleus tractus solitarius (nTS) in an in vitro en bloc brainstem spinal cord preparation. We hypothesized that both challenges would elicit similar changes in patterning of respiration. In anesthetized, spontaneously breathing rat pups, lipopolysaccharide (LPS) or saline was instilled in the airway of urethane-anesthetized rats (postnatal days 10-11). We recorded diaphragm EMG over the subsequent 2h and saw a 20-30% decrease in interburst interval (Te) at 20-80min post-injection in LPS-instilled animals with no significant change in Ti. In contrast, IL-1β injections into the nTS of en bloc in vitro brainstem-spinal cord preparations from 0 to 5 day-old pups maintained Ti and caused an increase in Te as early as 20min later, decreasing frequency for 80-120min after injection. Our results suggest that the neonatal respiratory response to the cytokine IL-1β mediated inflammatory response depends on the site of the inflammatory stimulus and that the direct effect of IL-1β in the nTS is to slow rather than increase rate.
[Show abstract][Hide abstract] ABSTRACT: The 1st International Neonatal and Maternal Immunization Symposium was held in Antalya, Turkey from 26 to 28 March 2010. Delegates who attended ranged from obstetricians and pediatricians to infectious diseases and immunization specialists. Topics covered included maternal and neonatal immunology, vaccine-specific responses in neonates and pregnant women, as well as vaccine safety and future vaccine strategies. Important new and emerging themes included: first, the idea that the neonatal immune system is not immature but is appropriate for the specific age and develops over time by as yet not well defined regulatory processes; second, that neonatal mucosal immunity is important and not well defined; third, that maternal pneumococcal immunization may be protective against pneumococcal disease in early infancy; and fourth, that monovalent H1N1 2009 influenza vaccine is safe and immunogenic in pregnant women.
Expert Review of Obstetrics & Gynecology 08/2010; 5(5):507-509. DOI:10.1586/eog.10.37
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