Dataset Information

Five Year Follow Up of Extremely Low Gestational Age Infants after Timely or Delayed Administration of Routine Vaccinations.

ABSTRACT: This study is aimed at detecting the rate of untimely immunization in a large cohort of extremely low gestational age neonates (ELGANs) of the German Neonatal Network (GNN) and at addressing risk factors for delayed vaccination and associated long-term consequences. We performed an observational study of the GNN between 1st January 2010 and 31st December 2019. The immunization status for the hexavalent and pneumococcal immunization was evaluated in n = 8401 preterm infants <29 weeks of gestation. Univariate analysis and logistic/linear regression models were used to identify risk factors for vaccination delay and outcomes at a 5-year follow-up. In our cohort n = 824 (9.8%) ELGANs did not receive a timely first immunization with the hexavalent and pneumococcal vaccine. Risk factors for delayed vaccination were SGA status (18.1% vs. 13.5%; OR 1.3; 95% CI: 1.1-1.7), impaired growth and surrogates for complicated clinical courses (i.e., need for inotropes, necrotizing enterocolitis). At 5 years of age, timely immunized children had a lower risk of bronchitis (episodes within last year: 27.3% vs. 37.7%; OR 0.60, 95% CI: 0.42-0.86) but spirometry measures were unaffected. In conclusion, a significant proportion of ELGANs are untimely immunized, specifically those with increased vulnerability, even though they might particularly benefit from the immune-promoting effects of a timely vaccination.

SUBMITTER: Fortmann I

PROVIDER: S-EPMC8150373 | biostudies-literature | 2021 May

REPOSITORIES: biostudies-literature

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Five Year Follow Up of Extremely Low Gestational Age Infants after Timely or Delayed Administration of Routine Vaccinations.

Fortmann Ingmar I Dammann Marie-Theres MT Humberg Alexander A Siller Bastian B Stichtenoth Guido G Engels Geraldine G Marißen Janina J Faust Kirstin K Hanke Kathrin K Goedicke-Fritz Sybelle S Derouet Christoph C Meyer Sascha S Stutz Regine R Kaiser Elisabeth E Herting Egbert E Göpel Wolfgang W Härtel Christoph C Zemlin Michael M On Behalf Of The German Neonatal Network Gnn And The Primal Consortium

Vaccines 20210512 5

This study is aimed at detecting the rate of untimely immunization in a large cohort of extremely low gestational age neonates (ELGANs) of the German Neonatal Network (GNN) and at addressing risk factors for delayed vaccination and associated long-term consequences. We performed an observational study of the GNN between 1st January 2010 and 31st December 2019. The immunization status for the hexavalent and pneumococcal immunization was evaluated in <i>n</i> = 8401 preterm infants <29 weeks of ge ...[more]

PMID: 34065878

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Project description:ImportanceThe standard schedule of national immunization programs for infants may not be sufficient to protect extremely and very preterm infants.ObjectiveTo evaluate the immunogenicity of routine vaccinations administered to preterm infants.Design, setting, and participantsA multicenter, prospective, observational cohort study of preterm infants stratified according to gestational age recruited from 8 hospitals across the Netherlands between October 2015 and October 2017, with follow-up until 12 months of age (October 2018). In total, 296 premature infants were enrolled and compared with a control group of 66 healthy term infants from a 2011 study, immunized according to the same schedule with the same vaccines.ExposuresThree primary doses of the diphtheria-tetanus toxoids-acellular pertussis-inactivated poliomyelitis-Haemophilus influenza type b-hepatitis B combination vaccine were given at 2, 3, and 4 months after birth followed by a booster at 11 months and a 10-valent pneumococcal conjugate vaccine at 2, 4, and 11 months after birth.Main outcomes and measuresPrimary end points were (1) proportion of preterm infants who achieved IgG antibody against vaccine antigens at concentrations above the internationally defined threshold for protection after the primary series and booster dose and (2) serum IgG geometric mean concentrations after the primary series and booster vaccination. Proportions and geometric mean concentrations were compared in preterm infants and the control group of term infants.ResultsOf 296 preterm infants (56.1% male; mean gestational age, 30 weeks), complete samples before vaccination, 1 month after the primary series, and 1 month after the booster were obtained from 220 preterm infants (74.3%). After the primary series, the proportion of preterm infants across all gestational age groups who achieved protective IgG antibody levels against pertussis toxin, diphtheria, tetanus and 6 of 10 pneumococcal serotypes varied between 83.0% and 100%, Haemophilus influenzae type b between 34.7% and 46.2% (40.6% among all preterm infants overall), and pneumococcal serotypes 4, 6B, 18C, and 23F between 45.8% and 75.1%. After the booster dose, protective antibody levels were achieved in more than 95% of all preterm groups, except for Haemophilus influenzae type b (88.1%). In general, geometric mean concentrations of all vaccine-induced antibodies were significantly lower in all preterm infants vs term infants, except for pertussis toxin and pneumococcal serotypes 4 and 19F after the primary series and booster vaccination.Conclusions and relevanceAmong preterm infants, administration of routine vaccinations during the first year of life was associated with protective antibody levels against most antigens in the majority of infants after the primary series and booster, except for Haemophilus influenzae type b. However, antibody concentrations were generally lower among preterm infants compared with historical controls.

Project description:ObjectiveTeleneonatology, the use of telemedicine for newborn resuscitation and care, can connect experienced care providers with high-risk deliveries. In a simulated resuscitation, we hypothesized that teleneonatal resuscitation, compared to usual resuscitation, would reduce the no-flow fraction.Study designThis was a single-center, randomized simulation trial in which pediatric residents were randomized to teleneonatal or routine resuscitation. The primary outcome was no-flow fraction defined as time without chest compressions divided by the time during which the heart rate was <60. Secondary outcomes included corrective modifications of bag-mask ventilation and times to intubation and epinephrine administration.ResultsFifty-one residents completed the scenario. The no-flow fraction (median [IQR]) was significantly better in the teleneonatal group (0.06[0.05]) compared to the routine resuscitation group (0.07[0.82]); effect (95% CI): -16 (-43 to 0). Participants in the teleneonatal resuscitation group more frequently performed corrective modifications to bag-mask ventilation (60% vs 15%; p < 0.001). Time to intubation (214 s vs 230 s; p = 0.58) and epinephrine (395 s vs 444 s; p = 0.21) were comparable between groups.ConclusionsIn this randomized simulation trial of neonatal resuscitation, teleneonatal resuscitation reduced adverse delivery outcomes compared to routine care. Further in hospital evaluation of teleneonatology may substantiate this technology's impact on delivery outcomes.ClinicaltrialsGov idNCT04258722 IMPACT: Whereas telemedicine-supported neonatal resuscitation may improve the quality of resuscitation within hospital settings, unique challenges include the need for real-time, high-fidelity audio-video communication with a low failure rate. The no-flow fraction, which evaluates the quality of chest compressions when indicated, has been associated with survival in other clinical contexts. We report a reduction in no-flow fraction in neonatal resuscitations supported with telemedicine, in addition to improvements in the quality of neonatal resuscitation. Telemedicine-supported neonatal resuscitation may improve the quality of resuscitation within hospital settings without direct access to neonatologists.

Project description:An increasing number of extremely premature infants survive the neonatal period and beyond. Little is known about the maturation of the preterm infant's metabolome and its relation to the development of morbidities. Using 1H-NMR, we investigated the serum metabolic profile of 87 infants born at a gestational age (GA) <28 weeks [mean GA (SD) 25.4 (1.4) weeks] in samples longitudinally collected from birth to term equivalent age. The infant metabolome was analyzed in relation to GA, postnatal age, nutrition, and preterm morbidities. At postnatal day 1, low GA correlated with high levels of 3-hydroxyisobutyrate, acetate, acetoacetate, acetone, formate, glucose, and valine. Nearly all quantified metabolites displayed postnatal concentration changes. For example, the two phospholipid-related metabolites myo-inositol and ethanolamine displayed a similar decline from birth over the first weeks of life, irrespectively of GA. The proportion of enteral/parenteral energy intake in the first 28 days significantly correlated with mean levels of 52% of the analyzed metabolites. Low enteral energy intake was associated with high serum levels of 3-hydroxyisobutyrate, creatinine, glucose, glycerol, histidine, lactate, leucine, lysine, methionine, ornithine, phenylalanine, proline, threonine, and uridine. There were also significant correlations between high enteral intake and high serum levels of isoleucine and tyrosine. Retinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD) outcomes were not significantly associated with metabolite levels in the neonatal period after correcting for multiple testing. In conclusion, the serum metabolome of extremely premature infants changes substantially in the neonatal period, largely driven by the gradual transfer from total parenteral nutrition to full enteral feeding. Further studies are needed to disentangle the intricate relationships between the metabolome, nutritional management, GA, and the development of preterm morbidities.

Dataset Information

Five Year Follow Up of Extremely Low Gestational Age Infants after Timely or Delayed Administration of Routine Vaccinations.

Publications

Five Year Follow Up of Extremely Low Gestational Age Infants after Timely or Delayed Administration of Routine Vaccinations.

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