早产儿第二次常规免疫接种后的心肺事件:风险评估与监测建议
Cardiorespiratory Events Following the Second Routine Immunization in Preterm Infants: Risk Assessment and Monitoring Recommendations.
作者信息
Bohnhorst Bettina, Weidlich Cornelia, Peter Corinna, Böhne Carolin, Kattner Evelyn, Pirr Sabine
机构信息
Department of Pediatric Pneumology, Allergology and Neonatology, Hannover Medical School, 30625 Hannover, Lower Saxony, Germany.
Department of Neonatology, Children's Hospital "Auf der Bult", 30173 Hannover, Lower Saxony, Germany.
出版信息
Vaccines (Basel). 2021 Aug 16;9(8):909. doi: 10.3390/vaccines9080909.
Due to frequent cardiorespiratory events (CREs) in response to the first routine immunization (rIM), current guidelines recommend readmitting and monitoring extremely preterm infants after the second rIM, though evidence on CREs in response to the second rIM is weak. In a prospective observational study, preterm infants with an increase in CREs after the first rIM were monitored for CREs before and after the second rIM. Seventy-one infants with a median gestational age of 26.4 weeks and a median weight of 820 g at birth were investigated at a median postnatal age of 94 days. All but seven infants showed an increase in CREs after the second rIM. The frequency of hypoxemias ( < 0.0001), apneas ( = 0.0003) and cardiorespiratory events requiring tactile stimulation (CRE-ts) ( = 0.0034) increased significantly. The 25 infants (35%) presenting with CRE-ts were significantly more likely to have been continuously hospitalized since birth ( = 0.001) and to receive analeptic therapy at the first rIM ( = 0.002) or some kind of respiratory support at the first ( = 0.005) and second rIM ( < 0.0001). At a postmenstruational age of 43.5 weeks, CRE-ts ceased. Our data support the recommendation to monitor infants who fulfil the above-mentioned criteria during the second rIM up to a postmenstruational age of 44 weeks.
由于首次常规免疫接种(rIM)后频繁出现心肺事件(CREs),目前的指南建议在第二次rIM后重新收治并监测极早产儿,尽管关于第二次rIM后CREs的证据不足。在一项前瞻性观察研究中,对首次rIM后CREs增加的早产儿在第二次rIM前后进行了CREs监测。研究调查了71例出生时中位胎龄为26.4周、中位体重为820 g的婴儿,中位出生后年龄为94天。除7例婴儿外,所有婴儿在第二次rIM后CREs均增加。低氧血症(<0.0001)、呼吸暂停(=0.0003)和需要触觉刺激的心肺事件(CRE-ts)(=0.0034)的发生率显著增加。出现CRE-ts的25例婴儿(35%)自出生后持续住院的可能性显著更高(=0.001),在首次rIM时接受兴奋药治疗的可能性更高(=0.002),在首次(=0.005)和第二次rIM时接受某种呼吸支持的可能性更高(<0.0001)。在月经后年龄为43.5周时,CRE-ts停止。我们的数据支持在第二次rIM期间对符合上述标准的婴儿进行监测直至月经后年龄44周的建议。
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