80 Mobile Cardiorespiratory Event Monitoring for Vaccination in Former Extremely Preterm Infants

Abstract

Background and aims Recommendations concerning the assessment of cardiorespiratory events during the first immunization with diphtheria-tetanus-pertussis-inactivated polio-Haemophilus influenzae type B ({DTP-IPV-Hib)} and Pneumococcal conjugate vaccine ({PCV)} of extremely preterm infants are discussed controversely. We examined the relationship between the immunization and cardiorespiratory events in preterm infants by using a mobile event monitor. Methods We enrolled 84 extremely preterm infants [39 girls, 45 boys; gestational age ({GA)} {\textless} 28.0 weeks (range 23.5-27.6)]. Immunization took place in the last week before discharge (mean {GA:} 38 weeks). Recording monitors were used continuously 12 hours before and during 48 hours after immunization to document prolonged apnea and bradycardia. Results The incidence of adverse cardiorespiratory events postimmunization ({PI)} was higher in the whole group with 40% of the infants having apneas {\textgreater}3 seconds longer than before immunization ({BI)}, and more prolonged events of bradycardia. The longest apnea observed {PI} was 20 seconds. Mean {PI} desaturations were more pronounced (76% {PI} vs. 67% {BI;} p{\textless}0.05). Furthermore, during the first 24 hours {PI} the mean oxygen saturation was lower, and the mean heart rate was significantly higher. In 40% of the children the second immunization was performed under continuous cardiorespiratory monitoring. Conclusions Preterm infants who received diphtheria-tetanuspertussis- inactivated polio-Haemophilus influenzae type B and pneumococcal vaccine before discharge were more likely to temporarily experience prolonged apnea and bradycardia after immunization. Continuous mobile event monitoring of these infants was a helpful tool to detect clinically significant cardiorespiratory events.