Incidence of apnoea and bradycardia in preterm infants following DTPw and Hib immunization: A prospective study

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Abstract
Objective: To evaluate the incidence and severity of apnoea and bradycardia in hospitalized preterm infants following immunization at 2 months of age, and identify risk factors. Methodology: A prospective study of 98 preterm infants, of gestational age 24–31 weeks, immunized at approximately 2 months post natal age with diphtheria‐tetanus‐whole cell pertussis vaccine (DTPw) in the neonatal intensive care unit (NICU) at King George V Hospital Sydney. Half the infants also received Haemophilus influenzae type b conjugate vaccine (Hib) simultaneously. All infants were monitored for apnoea and bradycardia in the 24 h periods pre‐ and post immunization. Results: Only one infant had apnoea and/or bradycardia pre‐immunization compared with 17 post immunization. For 12 infants these events were brief, self‐limiting and not associated with desaturations (oxygen saturation w were less likely to have apnoea and/or bradycardia than those given DTPw alone. Conclusion: When considering immunization for preterm infants, the benefits of early immunization must be balanced against the risk of apnoea and bradycardia. We recommend that the cardio‐respiratory function of hospitalized infants born at less than 31 weeks gestation be monitored for 48 h post immunization.