Department of Pediatrics, Madigan Army Medical Center, Tacoma, Washington.
Fort Belvoir Community Hospital, Virginia.
J Pediatric Infect Dis Soc. 2018 Aug 17;7(3):e58-e64. doi: 10.1093/jpids/pix079.
Low birth weight (LBW) has been associated with underimmunization. We sought to understand the effect of LBW on immunization completion after controlling for previously hypothesized mediators, including prematurity, neonatal illness, well-child care, non-well-child visits, and provider consistency.
We formed a retrospective cohort of infants born between 2008 and 2011 with ≥2 years of military healthcare follow-up. International Classification of Diseases, Ninth Revision codes were used to identify LBW, preterm birth, neonatal illnesses, well-child visits, non-well-child visits, provider consistency, and parental rank in the inpatient and outpatient records. Immunization records were extracted from both records. Logistic regression determined the odds of immunization completion and well-child care completion (ie, having had ≥6 WCC visits by 15 months of age).
Of 135964 included infants, 116521 (85.7%) were completely immunized at the age of 2 years. In adjusted analysis, the odds of immunization completion were significantly decreased in infants born at LBW (odds ratio [OR], 0.88 [95% confidence interval (CI), 0.79-0.97]), very LBW (OR, 0.61 [95% CI, 0.48-0.77]), or extremely LBW (OR, 0.45 [95% CI, 0.33-0.63]) or at ≤32 weeks' gestation (OR, 0.76 [95% CI, 0.63-0.92]), infants with chronic lung disease (OR, 0.63 [95% CI, 0.45-0.88]), male infants (OR, 0.96 [95% CI, 0.93-0.99]), and infants who experienced decreased provider consistency (OR, 0.92 [95% CI, 0.91-0.92]). The rate of immunization completion increased with the overall number of healthcare visits (OR, 1.02 [95% CI, 1.02-1.02]) and complete well-child care (OR, 1.80 [95% CI, 1.75-1.86]). However, children born LBW or preterm were significantly less likely to have complete well-child care.
After adjustment for preterm birth, comorbid neonatal conditions, and early childhood patterns of healthcare use, LBW was significantly associated with immunization noncompletion in a universal healthcare system. Provider consistency and well-child care seem important for increasing immunization completion in LBW infants.
低出生体重（LBW）与免疫接种不足有关。我们试图在控制先前假设的中介因素后，了解 LBW 对免疫接种完成的影响，这些因素包括早产、新生儿疾病、常规儿童保健、非常规儿童保健就诊和提供者一致性。
我们创建了一个由 2008 年至 2011 年间出生且有≥2 年军队医疗保健随访的婴儿组成的回顾性队列。使用国际疾病分类，第九修订版（International Classification of Diseases, Ninth Revision）代码在住院和门诊记录中识别 LBW、早产、新生儿疾病、常规儿童保健就诊、非常规儿童保健就诊、提供者一致性和父母职级。从这两个记录中提取免疫记录。逻辑回归确定免疫接种完成和常规儿童保健就诊完成（即，在 15 个月龄时接受≥6 次 WCC 就诊）的可能性。
在纳入的 135964 名婴儿中，有 116521 名（85.7%）在 2 岁时完全免疫接种。在调整分析中，LBW（比值比[OR]，0.88 [95%置信区间（CI），0.79-0.97]）、极低出生体重（OR，0.61 [95% CI，0.48-0.77]）或极低出生体重（OR，0.45 [95% CI，0.33-0.63]）或胎龄≤32 周（OR，0.76 [95% CI，0.63-0.92]）、慢性肺病（OR，0.63 [95% CI，0.45-0.88]）、男性婴儿（OR，0.96 [95% CI，0.93-0.99]）和经历提供者一致性降低（OR，0.92 [95% CI，0.91-0.92]）的婴儿免疫接种完成的可能性显著降低。免疫接种完成率随着整体医疗保健就诊次数的增加而增加（OR，1.02 [95% CI，1.02-1.02]）和常规儿童保健的完全完成（OR，1.80 [95% CI，1.75-1.86]）。然而，LBW 或早产出生的儿童接受常规儿童保健的可能性显著降低。
在调整早产、新生儿合并症和儿童早期医疗保健使用模式后，在普遍的医疗保健系统中，LBW 与免疫接种失败显著相关。提供者一致性和常规儿童保健对于提高 LBW 婴儿的免疫接种完成率似乎很重要。
