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Vol. 104, No. 2, 2013
Issue release date: August 2013
Neonatology 2013;104:151-155

Possible Predictors of Cardiorespiratory Events after Immunization in Preterm Neonates

Mialet-Marty T. · Beuchée A. · Ben Jmaa W.B. · N'Guyen N. · Navarro X. · Porée F. · Nuyt A.M. · Pladys P.
aINSERM, U1099, bLTSI, Université de Rennes 1, and cDivision of Neonatology and CIC, Department of Child and Adolescent Medicine, CHU Rennes, Rennes, France; dDivision of Neonatology and Centre de Recherche-CHU Ste Justine, Université de Montréal, Montréal, Que., Canada

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Background: The influence of the first immunization on cardiorespiratory (CR) stability in very preterm infants is still a controversial subject. Objectives: To describe the changes induced by immunization on heart and respiratory rate variability (HRV-RRV) and to test a potential association between preimmunization profiles and postimmunization CR events. Methods: Continuous 72-hour CR recordings and 2.5-hour polysomnographic recordings were performed on very preterm infants immunized after 7 weeks. The results are expressed as medians (interquartile ranges). Results: Immunization was performed on 31 very preterm infants [28 weeks' gestation (26.9-29), birth weight: 965 g (795-1,105)], and was associated with an increased incidence (p < 0.01) of events lasting more than 10 s: bradycardia <80 bpm [2.2 (1.1-7) vs. 1.8 (1-4)/12 h], desaturation [17.6 (9.4-36.4) vs. 13.9 (7.7-33.8)/12 h] and associated bradycardia-desaturation [IB+D, 4.1 (1.4-7.3) vs. 2.4 (1-4.6)/12 h], with mild changes in HRV and no change in RRV. The changes in IB+D frequency were correlated with preimmunization IB+D frequency (r = 0.44, p < 0.05), HRV spectral parameter low frequency/high frequency ratio (LF/HF, r = 0.55, p < 0.01) and approximate entropy of HRV (r = -0.39, p < 0.05). Conclusion: The increase in CR events after the first immunization in very preterm infants was associated with: (1) sympathetic predominance in heart rate control (high LF/HF ratio), (2) abnormal oversimplification of HRV (low entropy) and (3) persistent respiratory rhythm control immaturity (high IB+D before vaccine).

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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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  1. Saari TN: Immunization of preterm and low birth weight infants. American Academy of Pediatrics Committee on Infectious Diseases. Pediatrics 2003;112:193-198.

    External Resources

  2. Cooper PA, Madhi SA, Huebner RE, Mbelle N, Karim SS, Kleinschmidt I, Forrest BD, Klugman KP: Apnea and its possible relationship to immunization in ex-premature infants. Vaccine 2008;26:3410-3413.
  3. Slack MH, Schapira D: Severe apnoeas following immunisation in premature infants. Arch Dis Child Fetal Neonatal Ed 1999;81:F67-F68.
  4. Faldella G, Galletti S, Corvaglia L, Ancora G, Alessandroni R: Safety of DTaP-IPV-HIb-HBV hexavalent vaccine in very premature infants. Vaccine 2007;25:1036-1042.
  5. Flatz-Jequier A, Posfay-Barbe KM, Pfister RE, Siegrist CA: Recurrence of cardiorespiratory events following repeat DTaP-based combined immunization in very low birth weight premature infants. J Pediatr 2008;153:429-431.
  6. Pfister RE, Aeschbach V, Niksic-Stuber V, Martin BC, Siegrist CA: Safety of DTaP-based combined immunization in very-low-birth-weight premature infants: frequent but mostly benign cardiorespiratory events. J Pediatr 2004;145:58-66.
  7. Schulzke S, Heininger U, Lucking-Famira M, Fahnenstich H: Apnoea and bradycardia in preterm infants following immunisation with pentavalent or hexavalent vaccines. Eur J Pediatr 2005;164:432-435.
  8. Sen S, Cloete Y, Hassan K, Buss P: Adverse events following vaccination in premature infants. Acta Paediatr 2001;90:916-920.
  9. Carbone T, McEntire B, Kissin D, Kelly D, Steinschneider A, Violaris K, Karamchandani N: Absence of an increase in cardiorespiratory events after diphtheria-tetanus-acellular pertussis immunization in preterm infants: a randomized, multicenter study. Pediatrics 2008;121:e1085-e1090.
  10. Ahmad S, Tejuja A, Newman KD, Zarychanski R, Seely AJ: Clinical review: a review and analysis of heart rate variability and the diagnosis and prognosis of infection. Crit Care 2009;13:232.
  11. Fairchild KD, Srinivasan V, Moorman JR, Gaykema RP, Goehler LE: Pathogen-induced heart rate changes associated with cholinergic nervous system activation. Am J Physiol Regul Integr Comp Physiol 2011;300:R330-R339.
  12. Moorman JR, Carlo WA, Kattwinkel J, Schelonka RL, Porcelli PJ, Navarrete CT, Bancalari E, Aschner JL, Whit Walker M, Perez JA, Palmer C, Stukenborg GJ, Lake DE, Michael O'Shea T: Mortality reduction by heart rate characteristic monitoring in very low birth weight neonates: a randomized trial. J Pediatr 2011;159:900-906.e1.
  13. Franco P, Szliwowski H, Dramaix M, Kahn A: Polysomnographic study of the autonomic nervous system in potential victims of sudden infant death syndrome. Clin Auton Res 1998;8:243-249.
  14. Debillon T, Zupan V, Ravault N, Magny JF, Dehan M: Development and initial validation of the EDIN scale, a new tool for assessing prolonged pain in preterm infants. Arch Dis Child Fetal Neonatal Ed 2001;85:F36-F41.
  15. Beuchee A, Carrault G, Bansard JY, Boutaric E, Betremieux P, Pladys P: Uncorrelated randomness of the heart rate is associated with sepsis in sick premature infants. Neonatology 2009;96:109-114.
  16. Beuchee A, Hernandez AI, Duvareille C, Daniel D, Samson N, Pladys P, Praud JP: Influence of hypoxia and hypercapnia on sleep state-dependent heart rate variability behavior in newborn lambs. Sleep 2012;35:1541-1549.
  17. Pan J, Tompkins WJ: A real-time QRS detection algorithm. IEEE Trans Biomed Eng 1985;32:230-236.

    External Resources

  18. Gonzalez JJ, Cordero JJ, Feria M, Pereda E: Detection and sources of nonlinearity in the variability of cardiac R-R intervals and blood pressure in rats. Am J Physiol Heart Circ Physiol 2000;279:H3040-H3046.

    External Resources

  19. Perkiomaki JS: Heart rate variability and non-linear dynamics in risk stratification. Front Physiol 2011;2:81.
  20. Lee J, Robinson JL, Spady DW: Frequency of apnea, bradycardia, and desaturations following first diphtheria-tetanus-pertussis-inactivated polio-haemophilus influenzae type B immunization in hospitalized preterm infants. BMC Pediatr 2006;6:20.
  21. Thayer JF, Yamamoto SS, Brosschot JF: The relationship of autonomic imbalance, heart rate variability and cardiovascular disease risk factors. Int J Cardiol 2010;141:122-131.
  22. Rantonen T, Jalonen J, Gronlund J, Antila K, Southall D, Valimaki I: Increased amplitude modulation of continuous respiration precedes sudden infant death syndrome - detection by spectral estimation of respirogram. Early Hum Dev 1998;53:53-63.
  23. Pincus SM, Cummins TR, Haddad GG: Heart rate control in normal and aborted-SIDS infants. Am J Physiol 1993;264:R638-R646.

    External Resources

  24. Filiano JJ, Kinney HC: A perspective on neuropathologic findings in victims of the sudden infant death syndrome: the triple-risk model. Biol Neonate 1994;65:194-197.

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