Lee Jackie, Robinson Joan L, Spady Donald W
Stollery Children's Hospital and Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.
BMC Pediatr. 2006 Jun 19;6:20. doi: 10.1186/1471-2431-6-20.
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.
Infants with gestational age of < or = 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.
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.
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.
已有报道称，对早产儿首次接种白喉-破伤风-百日咳-灭活脊髓灰质炎- b型流感嗜血杆菌（DTP-IPV-Hib）疫苗后会出现包括呼吸暂停、心动过缓和血氧饱和度下降在内的不良心肺事件。近期用无细胞百日咳疫苗替代全细胞百日咳疫苗对这些事件发生频率的影响有待进一步研究。
1996年1月1日至2000年11月30日期间，在埃德蒙顿两家新生儿重症监护病房出院前首次接种DTP-IPV-Hib疫苗、胎龄小于或等于32周的婴儿符合本研究条件。每例接种疫苗的婴儿按胎龄与一名对照婴儿匹配。记录接种疫苗前72小时和接种疫苗后72小时（接种疫苗队列）或相同出生后年龄（对照队列）出现的呼吸暂停、心动过缓和/或血氧饱和度下降（ABD）发作次数以及这些发作所需的治疗。
34例接种含全细胞百日咳疫苗的DTP-IPV-Hib疫苗的婴儿、90例接种含无细胞百日咳疫苗的DTP-IPV-Hib疫苗的婴儿和124例对照婴儿纳入研究。56例接种疫苗的婴儿（45.1%）和36例对照婴儿（29.0%）在接种疫苗后72小时内或对照婴儿相同出生后年龄时出现ABD复发或增加，接种疫苗婴儿与对照婴儿相比，调整后的优势比为2.41（95%CI 1.29,4.51）。接种全细胞或无细胞百日咳疫苗的婴儿接种疫苗后不良心肺事件增加的发生率相同（44.1%对45.6%）。18例接种疫苗的婴儿（14.5%）和51例对照婴儿（41.1%）在接种疫苗后72小时内或对照婴儿相同出生后年龄时ABD减少，优势比为0.175（95%CI 0.08,0.39）。接种疫苗婴儿对ABD进行治疗的需求与对照婴儿无统计学差异。接种疫苗时体重较低是接种疫苗后ABD复发或增加的危险因素。出生体重、胎龄、出生后年龄或性别不是危险因素。
早产儿首次接种DTP-IPV-Hib疫苗后不良心肺事件增加。目前体重较低被确定为危险因素，全细胞百日咳疫苗与无细胞百日咳疫苗的风险相当。尽管这些事件大多临床意义有限，但对于胎龄足够小、在出院前接受首次免疫接种的婴儿，应在接种疫苗后72小时进行心肺监测。
