Increased risk for bronchitis after discharge in non-vaccinated very low birth weight infants.
BACKGROUND
In very low birth weight (VLBW) infants, obstructive bronchitis is a frequent cause of hospital re-admission. For VLBW infants, early vaccinations starting at 2 months after birth have been recommended.


OBJECTIVE
To analyze risk factors for bronchitis during the first year after discharge and the effects of in-hospital standard vaccination (hexavalent/pneumococci) and/or RSV immunoprophylaxis with palivizumab.


METHODS
A standardized questionnaire was sent to the parents of VLBW infants 7 month after discharge. The reported episodes of bronchitis were correlated with clinically recorded parameters including risk factors for pulmonary morbidity. The effects of in-hospital vaccination were assessed in a subgroup discharged after day 60.


RESULTS
A sample of 1 967 responses of infants born 2009-2011 was analyzed. Risk factors for bronchitis were male gender and older siblings. 24% of the population had episodes of bronchitis. In the subgroup discharged after day 60, episodes of bronchitis were reported for 31% of infants who were not vaccinated in-hospital. A significant reduction of the bronchitis rate was found in infants who received palivizumab±standard vaccination (17% bronchitis, p=0.003). Interestingly, in-hospital standard vaccination without RSV immunoprophylaxis was protective (20% bronchitis; p=0.037) as well.


CONCLUSIONS
Non-vaccinated male VLBW infants with older siblings are at increased risk for bronchitis during the first year after discharge. Vaccination according to schedule seems to have protective effects, while underlying mechanisms are unknown. The rate of timely vaccination in preterm infants should be increased.
Department of Pediatrics, University Hospital of Schleswig-Holstein, Lübeck, Germany.
G
G
Stichtenoth
Department of Pediatrics, University Hospital of Schleswig-Holstein, Lübeck, Germany.
C
C
Härtel
Department of Pediatrics, University Hospital of Schleswig-Holstein, Lübeck, Germany.
J
J
Spiegler
Department of Paediatrics, Diakonissenkrankenhaus, Flensburg, Germany.
M
M
Dördelmann
Department of Pediatrics, Saarbrücken General Hospital, Saarbrücken, Germany.
J
J
Möller
Department of Neonatology, Children's Hospital, Aschaffenburg, Germany.
C
C
Wieg
Department of Neonatology, University Hospital Aachen, Aachen, Germany.
T
T
Orlikowsky
Departments of Pediatrics I, Neonatology, University Hospital, Essen, Germany.
A
A
Stein
Department of Pediatrics, University Hospital of Schleswig-Holstein, Lübeck, Germany.
E
E
Herting
Department of Pediatrics, University Hospital of Schleswig-Holstein, Lübeck, Germany.
W
W
Goepel
D001991:Bronchitis / Q000209:etiology* / Q000517:prevention & control*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control*; D019102:Infant, Very Low Birth Weight; D008297:Male; D000069455:Palivizumab / Q000008:administration & dosage; D010351:Patient Discharge; D018357:Respiratory Syncytial Virus Infections / Q000209:etiology* / Q000401:mortality / Q000517:prevention & control*; D022261:Respiratory Syncytial Virus Vaccines / Q000008:administration & dosage*; D012307:Risk Factors; D011795:Surveys and Questionnaires; D016019:Survival Analysis
D022261:Respiratory Syncytial Virus Vaccines; D000069455:Palivizumab