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 ≥2 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)To read this article in full you will need to make a payment
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Article Info
Publication History
Published online: June 26, 2007
Accepted:
February 21,
2007
Received in revised form:
December 29,
2006
Received:
April 14,
2006
Identification
Copyright
© 2007 Mosby, Inc. Published by Elsevier Inc. All rights reserved.
