Study: Apnea more common among preterm infants who receive 2-month vaccines
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Key takeaways:
- Vaccinated infants were 2.7 times more likely to experience apnea compared with unvaccinated infants, but no serious adverse events occurred in either group.
- The study’s findings support current recommendations.
Short-term apnea is more common among hospitalized preterm infants who receive their 2-month vaccines compared with those who do not, according to the results of a randomized clinical trial published in JAMA Pediatrics.
However, the trial found no difference in the duration or number of apnea episodes between the vaccinated and unvaccinated groups, and researchers did not identify any serious adverse events among participants.
The results align with existing warnings, are consistent with previous research and support current recommendations to vaccinate hospitalized preemies, the researchers said.
The AAP and CDC’s Advisory Committee on Immunization Practices (ACIP) recommend preterm infants receive vaccines at the same chronological age as infants born at term, except for hepatitis B virus and rotavirus vaccines, but preterm infants are often undervaccinated, according to Rachel G. Greenberg, MD, MB, MHS, a neonatologist and associate professor of pediatrics at Duke University Medical Center and Duke Clinical Research Institute, and colleagues.
“Only half of infants discharged from the neonatal intensive care unit after lengths of stay of 60 days or longer are fully vaccinated,” Greenberg and colleagues wrote. “The perceived risk of apnea after vaccination in preterm infants likely contributes, and this risk is noted as a warning and precaution in vaccine package inserts for routinely administered infant vaccines.”
Greenberg and colleagues conducted a randomized clinical trial of 223 hospitalized infants (52% girls; median gestational age, 27.6 weeks) who were born between 23 and 33 weeks’ gestational age from August 2018 to October 2021 at three NICUs in the United States. They randomly assigned 107 infants (48%) to receive vaccines at age 2 months, and 116 (52%) infants to not receive any vaccines until the study period concluded.
Infants in the vaccinated group received DTaP; the 13-valent pneumococcal conjugate vaccine; and vaccines for HBV, polio and Haemophilus influenzae type b.
The researchers monitored the infants for 48 hours after vaccination to document episodes of apnea — a pause in breathing that lasts longer than 20 seconds or other interruptions to breathing combined with bradycardia.
Overall, 17% of infants experienced at least one apnea event, according to Greenberg and colleagues. Vaccinated infants were more than twice as likely to experience apnea than those who were unvaccinated (24% vs. 10%; adjusted OR = 2.7; 95% CI, 1.27-5.73).
There was no statistically significant difference in the average number or duration of apnea events between the vaccinated and unvaccinated groups, and there were no serious adverse events in either group, the researchers reported.
Infants in the vaccinated group experienced more apnea events in the 12 days after the study period concluded, which the authors noted may point to underlying disease rather than complications from the vaccines.
“Despite the higher odds of apnea in the vaccinated group, the overall incidence of secondary outcomes, including escalation in respiratory support or receipt of positive pressure ventilation, was low,” Greenberg and colleagues wrote. “The study supports the current ACIP recommendations to vaccinate hospitalized preterm infants at 2 months chronological age in most situations according to the same schedule and using the same contraindications and precautions as for full-term infants and children.”
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