title: 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.
abstract: 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.
  
  
  METHODS
  Prospective observational study on 239 preterm infants at > or =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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatrics, The University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA. mpourcyrous@utmem.edu
authors.forename: Massroor
authors.initials: M
authors.lastname: Pourcyrous
authors.forename: Sheldon B
authors.initials: SB
authors.lastname: Korones
authors.forename: Kristopher L
authors.initials: KL
authors.lastname: Arheart
authors.forename: Henrietta S
authors.initials: HS
authors.lastname: Bada
mesh_terms: D001049:Apnea / Q000453:epidemiology / Q000209:etiology / Q000503:physiopathology; D001919:Bradycardia / Q000453:epidemiology / Q000209:etiology*; D001997:Bronchopulmonary Dysplasia / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology; D002097:C-Reactive Protein / Q000032:analysis*; D015331:Cohort Studies; D015721:Diphtheria-Tetanus-Pertussis Vaccine / Q000008:administration & dosage / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D007114:Immunization / Q000009:adverse effects* / Q000379:methods; D015994:Incidence; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D008297:Male; D011054:Poliovirus Vaccine, Inactivated / Q000008:administration & dosage / Q000009:adverse effects; D011446:Prospective Studies; D018570:Risk Assessment; D017778:Vaccines, Combined / Q000009:adverse effects; D014765:Viral Vaccines / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D015721:Diphtheria-Tetanus-Pertussis Vaccine; D011054:Poliovirus Vaccine, Inactivated; D017778:Vaccines, Combined; D014765:Viral Vaccines; D002097:C-Reactive Protein