Hexavalent vaccines in preterm infants: an update by Italian Society of Pediatric Allergy and Immunology jointly with the Italian Society of Neonatology

AbstractHexavalent vaccines, protecting against six diseases (diphtheria, tetanus, pertussis [DTaP], poliovirus, hepatitis B virus [HBV], and Haemophilus influenzae type b [Hib], are routinely the standard of care in Europe. The use of combined vaccines allows the reduction of number of injections and side effects, the reduction of costs, and the increase in adherence of the family to the vaccination schedule both in terms of the number of doses and timing. The safety profile, efficacy and effectiveness of hexavalent vaccines have been extensively documented in infants and children born at term, and data are accumulating in preterm infants. Hexavalent vaccines are particularly important for preterm infants, who are at increased risk for severe forms of vaccine preventable diseases. However, immunization delay has been commonly reported in this age group. All the three hexavalent vaccines currently marketed in Italy can be used in preterm infants, and recent data confirm that hexavalent vaccines have a similar or lower incidence of adverse events in preterm compared to full-term infants; this is likely due to a weaker immune system response and reduced ability to induce an inflammatory response in preterm infants. Apnoea episodes are the adverse events that can occur in the most severe preterm infants and / or with history of respiratory distress. The risk of apnoea after vaccination seems to be related to a lower gestational age and a lower birth weight, supporting the hypothesis that it represents an unspecific response of the preterm infant to different procedures. High seroprotection rates have been reported in preterm infants vaccinated with hexavalent vaccine. However, a lower gestational age seems to be associated with lower antibody titres against some vaccine antigens (e.g. HBV, Hib, poliovirus serotype 1, and pertussis), regardless of the type of hexavalent vaccine used. Waiting for large effectiveness studies, hexavalent vaccines should be administered in preterm infants according to the same schedule recommended for infants born at term, considering their chronological age and providing an adequate monitoring for cardio-respiratory events in the 48–72 h after vaccination, especially for infants at risk of recurrence of apnoea.

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Respiratory Syncytial Virus in Otherwise Healthy Prematurely Born Infants: A Forgotten Majority

American Journal of Perinatology ◽

10.1055/s-0038-1637762 ◽

2018 ◽

Vol 35 (06) ◽

pp. 541-544 ◽

Cited By ~ 5

Author(s):

Bosco Paes

Keyword(s):

Respiratory Syncytial Virus ◽

Preterm Infants ◽

Premature Infants ◽

Gestational Age ◽

Burden Of Illness ◽

Hospital Costs ◽

Chronic Obstructive ◽

Term Infants ◽

Increased Risk ◽

Syncytial Virus

AbstractHealthy, premature infants ≤35 weeks' gestational age (wGA) are universally recognized to be at an increased risk of perinatal morbidity and mortality. Serious respiratory syncytial virus (RSV) lower respiratory tract infection imposes an additional burden of illness on these infants following hospitalization. Incurred morbidities relative to term infants include longer lengths of hospital stay, admission to intensive care, and need for oxygen and mechanical ventilation, all of which are associated with increased hospital costs. The highest morbidities are experienced by premature infants who are youngest (<3 months' chronological age) and are of lower gestational age. Short- and long-term follow-up indicates that healthy preterm infants both of lower gestational age and who are late preterm have obstructive lung function at baseline, which is further compromised by RSV-related infection during infancy. There is increasing evidence that childhood exposure to an episode of RSV infection may set the stage for an abnormal respiratory function trajectory, which, in adulthood, leads to chronic obstructive pulmonary disease. Healthy premature infants <32 wGA merit RSV prophylaxis based on existing data, whereas moderate- and high-risk preterm infants 32 to 35 wGA should be selectively and cost-effectively targeted for prophylaxis using validated risk scoring tools and country-specific thresholds for funding.

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Association Between Paternal Age and Birth Weight in Preterm and Full-Term Birth: A Retrospective Study

Frontiers in Endocrinology ◽

10.3389/fendo.2021.706369 ◽

2021 ◽

Vol 12 ◽

Author(s):

Yiting Mao ◽

Chen Zhang ◽

Yinyu Wang ◽

Yicong Meng ◽

Lei Chen ◽

...

Keyword(s):

Retrospective Study ◽

Birth Weight ◽

Preterm Infants ◽

Gestational Age ◽

Paternal Age ◽

Large For Gestational Age ◽

Term Infants ◽

Advanced Paternal Age ◽

Increased Risk ◽

Infant Birth

PurposeWhile it is well documented that maternal adverse exposures contribute to a series defects on offspring health according to the Developmental Origins of Health and Disease (DOHaD) theory, paternal evidence is still insufficient. Advanced paternal age is associated with multiple metabolism and psychiatric disorders. Birth weight is the most direct marker to evaluate fetal growth. Therefore, we designed this study to explore the association between paternal age and birth weight among infants born at term and preterm (<37 weeks gestation).MethodsA large retrospective study was conducted using population-based hospital data from January 2015 to December 2019 that included 69,964 cases of singleton infant births with complete paternal age data. The primary outcome was infant birth weight stratified by sex and gestational age including small for gestational age (SGA, 10th percentile) and large for gestational age (LGA, 90th percentile). Birth weight percentiles by gestational age were based on those published in the INTERGROWTH-21st neonatal weight-for gestational-age standard. Logistic regression analysis and linear regression model were used to estimate the association between paternal age and infant birth weight.ResultsAdvanced paternal age was associated with a higher risk for a preterm birth [35–44 years: adjusted odds ratio (OR) = 1.13, 95%CI (1.03 to 1.24); >44 years: OR = 1.36, 95%CI (1.09 to 1.70)]. Paternal age exerted an opposite effect on birth weight with an increased risk of SGA among preterm infants (35–44years: OR = 1.85, 95%CI (1.18 to 2.89) and a decreased risk among term infant (35–44years: OR = 0.81, 95%CI (0.68 to 0.98); >44 years: OR = 0.50, 95%CI (0.26 to 0.94). U-shaped associations were found in that LGA risk among term infants was higher in both younger (<25 years) (OR = 1.32; 95%CI, 1.07 to 1.62) and older (35–44 years) (OR = 1.07; 95% CI, 1.01 to 1.14) fathers in comparison to those who were 25 to 34 years old at the time of delivery.ConclusionsOur study found advanced paternal age increased the risk of SGA among preterm infants and for LGA among term infants. These findings likely reflect a pathophysiology etiology and have important preconception care implications and suggest the need for antenatal monitoring.

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Prevalence of small for gestational age infants in 21 cities in China, 2014–2019

Scientific Reports ◽

10.1038/s41598-021-87127-9 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Hui He ◽

Huazhang Miao ◽

Zhijiang Liang ◽

Ye Zhang ◽

Wei Jiang ◽

...

Keyword(s):

Gestational Age ◽

Small For Gestational Age ◽

Health Information System ◽

Guangdong Province ◽

Significant Negative Correlation ◽

Term Infants ◽

Per Capita Gdp ◽

Increased Risk ◽

Per Capita ◽

Epidemiological Characteristics

AbstractInfants who are small for gestational age (SGA) are at increased risk of neonatal and infant death, non-communicable diseases and growth retardation. However, the epidemiological characteristics of SGA remain unclear. We aim to explore the prevalence of SGA and to examine its socioeconomic associations by using data from 21 cities. 10,515,494 single live birth records between 2014 and 2019 from the Guangdong Women and Children Health Information System were included in the study. Descriptive statistical methods were used to analyze the prevalence trend of SGA and its distribution. We also analyze the associations between the prevalence of SGA and per-capita GDP. The prevalence of SGA in Guangdong Province from the years 2014–2019 was 13.17%, 12.96%, 11.96%, 12.72%, 11.45%, 11.30% respectively, and the overall prevalence was 12.28%. The prevalence of term SGA infants in Guangdong Province was 12.50%, which was much higher than that of preterm SGA (7.71%). There was a significant negative correlation between the SGA prevalence and per-capita GDP in 21 cities of Guangdong Province. The level of economic development may affect the prevalence of SGA. The prevalence of SGA in full term infants is significantly higher than in premature infants, suggesting that most SGA infants may be born at a later gestational age.

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Vaccinations in Infants Born Preterm: An Update

Current Pediatric Reviews ◽

10.2174/157339631666620011609445 ◽

2020 ◽

Vol 16 (2) ◽

pp. 148-155

Author(s):

Areti Aphrodite Sioriki ◽

Despoina Gkentzi ◽

Evangelia Papadimitriou ◽

Gabriel Dimitriou ◽

Ageliki Karatza

Keyword(s):

Preterm Infants ◽

Vaccine Safety ◽

Full Term ◽

Morbidity And Mortality ◽

Term Infants ◽

Safety And Efficacy ◽

Vaccine Preventable Diseases ◽

Increased Risk ◽

Protective Antibodies

Infants born prematurely (before completion of 37 weeks of gestation) are at increased risk of morbidity and mortality due to vaccine preventable diseases, mostly because of their immunological immaturity and failure of transfer of maternal protective antibodies. Despite their great need of being vaccinated, concerns on vaccine safety and efficacy, constitute the main reasons for which vaccinations are often delayed in this group. In this review we summarize the latest evidence on vaccine safety, efficacy and immunogenicity in preterm infants which is similar to full-term infants. Therefore there is no reason for delaying vaccination in this population.

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Investigating whether adverse prenatal and perinatal events are associated with non-clinical psychotic symptoms at age 12 years in the ALSPAC birth cohort

Psychological Medicine ◽

10.1017/s0033291708005126 ◽

2009 ◽

Vol 39 (9) ◽

pp. 1457-1467 ◽

Cited By ~ 73

Author(s):

S. Zammit ◽

D. Odd ◽

J. Horwood ◽

A. Thompson ◽

K. Thomas ◽

...

Keyword(s):

Longitudinal Study ◽

Adverse Events ◽

Birth Cohort ◽

Early Development ◽

Gestational Age ◽

Apgar Score ◽

Psychotic Symptoms ◽

Maternal Infection ◽

Increased Risk ◽

Clinical Disorders

BackgroundNon-clinical psychosis-like symptoms (PLIKS) occur in about 15% of the population. It is not clear whether adverse events during early development alter the risk of developing PLIKS. We aimed to examine whether maternal infection, diabetes or pre-eclampsia during pregnancy, gestational age, perinatal cardiopulmonary resuscitation or 5-min Apgar score were associated with development of psychotic symptoms during early adolescence.MethodA longitudinal study of 6356 12-year-old adolescents who completed a semi-structured interview for psychotic symptoms in the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort. Prenatal and perinatal data were obtained from obstetric records and maternal questionnaires completed during pregnancy.ResultsThe presence of definite psychotic symptoms was associated with maternal infection during pregnancy [adjusted odds ratio (OR) 1.44, 95% confidence interval (CI) 1.11–1.86, p=0.006], maternal diabetes (adjusted OR 3.43, 95% CI 1.14–10.36, p=0.029), need for resuscitation (adjusted OR 1.50, 95% CI 0.97–2.31, p=0.065) and 5-min Apgar score (adjusted OR per unit decrease 1.30, 95% CI 1.12–1.50, p<0.001). None of these associations were mediated by childhood IQ score. Most associations persisted, but were less strong, when including suspected symptoms as part of the outcome. There was no association between PLIKS and gestational age or pre-eclampsia.ConclusionsAdverse events during early development may lead to an increased risk of developing PLIKS. Although the status of PLIKS in relation to clinical disorders such as schizophrenia is not clear, the similarity between these results and findings reported for schizophrenia indicates that future studies of PLIKS may help us to understand how psychotic experiences and clinical disorders develop throughout the life-course.

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Comparison of neonatal outcomes of small for gestational age and appropriate for gestational age preterm infants born at 28–36 weeks of gestation: a multicentre study in Ethiopia

BMJ Paediatrics Open ◽

10.1136/bmjpo-2020-000740 ◽

2020 ◽

Vol 4 (1) ◽

pp. e000740

Author(s):

Netsanet Workneh Gidi ◽

Robert L Goldenberg ◽

Assaye K Nigussie ◽

Elizabeth McClure ◽

Amha Mekasha ◽

...

Keyword(s):

Preterm Infants ◽

Gestational Age ◽

Small For Gestational Age ◽

Late Onset ◽

Early Recognition ◽

Neonatal Outcomes ◽

P Value ◽

Prolonged Hospitalisation ◽

Increased Risk ◽

Appropriate For Gestational Age

PurposeThe aim of this study was to assess morbidity and mortality pattern of small for gestational age (SGA) preterm infants in comparison to appropriate for gestational age (AGA) preterm infants of similar gestational age.MethodWe compared neonatal outcomes of 1336, 1:1 matched, singleton SGA and AGA preterm infants based on their gestational age using data from the study ‘Causes of Illness and Death of Preterm Infants in Ethiopia (SIP)’. Data were analysed using SPSS V.23. ORs and 95% CIs and χ2 tests were done, p value of <0.05 was considered statistically significant.ResultThe majority of the infants (1194, 89%) were moderate to late preterm (32–36 weeks of gestation), 763 (57%) were females. Male preterm infants had higher risk of being SGA than female infants (p<0.001). SGA infants had increased risk of hypoglycaemic (OR and 95% CI 1.6 (1.2 to 2.0), necrotising enterocolitis (NEC) 2.3 (1.2 to 4.1), polycythaemia 3.0 (1.6 to 5.4), late-onset neonatal sepsis (LOS) 3.6 (1.1 to 10.9)) and prolonged hospitalisation 2.9 (2.0 to 4.2). The rates of respiratory distress syndrome (RDS), apnoea and mortality were similar in the SGA and AGA groups.ConclusionNeonatal complications such as hypoglycaemic, NEC, LOS, polycythaemia and prolonged hospitalisation are more common in SGA infants, while rates of RDS and mortality are similar in SGA and AGA groups. Early recognition of SGA status, high index of suspicion and screening for complications associated and timely intervention to prevent complications need due consideration.

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New charts for the assessment of body composition, according to air-displacement plethysmography, at birth and across the first 6 mo of life

American Journal of Clinical Nutrition ◽

10.1093/ajcn/nqy377 ◽

2019 ◽

Vol 109 (5) ◽

pp. 1353-1360 ◽

Cited By ~ 13

Author(s):

Tom Norris ◽

Sara E Ramel ◽

Patrick Catalano ◽

Carol ni Caoimh ◽

Paola Roggero ◽

...

Keyword(s):

United States ◽

Body Composition ◽

Preterm Infants ◽

Fat Mass ◽

Gestational Age ◽

The United States ◽

Fat Free Mass ◽

Term Infants ◽

Air Displacement Plethysmography ◽

Young Infants

ABSTRACT Background Air-displacement plethysmography (ADP) is a good candidate for monitoring body composition in newborns and young infants, but reference centile curves are lacking that allow for assessment at birth and across the first 6 mo of life. Objective Using pooled data from 4 studies, we aimed to produce new charts for assessment according to gestational age at birth (30 + 1 to 41 + 6 wk) and postnatal age at measurement (1–27 wk). Methods The sample comprised 222 preterm infants born in the United States who were measured at birth; 1029 term infants born in Ireland who were measured at birth; and 149 term infants born in the United States and 57 term infants born in Italy who were measured at birth, 1 and 2 wk, and 1, 2, 3, 4, 5, and 6 mo of age. Infants whose birth weights were <3rd or >97th centile of the INTERGROWTH-21st standard were excluded, thereby ensuring that the charts depict body composition of infants whose birth weights did not indicate suboptimal fetal growth. Sex-specific centiles for fat mass (kg), fat-free mass (kg), and percentage body fat were estimated using the lambda-mu-sigma (LMS) method. Results For each sex and measure (e.g., fat mass), the new charts comprised 2 panels. The first showed centiles according to gestational age, allowing term infants to be assessed at birth and preterm infants to be monitored until they reached term. The second showed centiles according to postnatal age, allowing all infants to be monitored to age 27 wk. The LMS values underlying the charts were presented, enabling researchers and clinicians to convert measurements to centiles and z scores. Conclusions The new charts provide a single tool for the assessment of body composition, according to ADP, in infants across the first 6 mo of life and will help enhance early-life nutritional management.

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Circulating Peptide YY Concentrations Are Higher in Preterm than Full-Term Infants and Correlate Negatively with Body Weight and Positively with Serum Ghrelin Concentrations

Clinical Chemistry ◽

10.1373/clinchem.2005.054908 ◽

2005 ◽

Vol 51 (11) ◽

pp. 2131-2137 ◽

Cited By ~ 19

Author(s):

Tania Siahanidou ◽

Helen Mandyla ◽

Maria Vounatsou ◽

Dimitris Anagnostakis ◽

Ioannis Papassotiriou ◽

...

Keyword(s):

Body Mass Index ◽

Body Weight ◽

Energy Balance ◽

Food Intake ◽

Preterm Infants ◽

Gestational Age ◽

Peptide Yy ◽

Full Term ◽

Term Infants ◽

Serum Ghrelin

Abstract Background: Peptide YY (PYY) and ghrelin are gastrointestinal tract–derived hormones that play roles in the regulation of food intake and energy balance. Negative energy balance often occurs in hospitalized preterm infants. Methods: To measure serum concentrations of PYY in preterm and full-term infants and to investigate their correlations with anthropometric characteristics, food intake, and serum ghrelin concentrations, we measured serum PYY and ghrelin concentrations by RIA in 62 healthy preterm infants [mean (SD) gestational age, 32.0 (2.1) weeks; postnatal age, 40.9 (14.8) days] and 15 healthy full-term infants of comparable postnatal age. All of the infants were formula-fed every 3 h. Results: PYY concentrations were significantly higher in preterm [1126.2 (215.4) ng/L] than in full-term infants [825.3 (234.4) ng/L; P <0.001]. In the entire study population, serum PYY concentrations correlated negatively with gestational age and anthropometric measurements (birth weight, body weight, body length, body mass index, and head circumference) and positively with serum ghrelin concentrations, whereas there was no significant correlation between PYY concentration and caloric intake or weight gain. Multiple regression analysis, after correction for prematurity, revealed that serum PYY concentrations correlated independently with serum ghrelin concentrations and infant body weight or body mass index. Conclusions: Circulating concentrations of PYY may increase in preterm infants to compensate for the negative body-weight balance. The physiologic mechanisms behind the correlation between PYY and ghrelin remain to be elucidated.

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CHARACTERISTICS OF THE METABOLIC STATUS OF CHILDREN OF THE FIRST YEAR OF LIFE WITH PROTEIN-ENERGY DEFICIENCY DEPENDING ON THE GESTATIONAL AGE AT BIRTH

Russian Clinical Laboratory Diagnostics ◽

10.18821/0869-2084-2020-65-7-405-410 ◽

2020 ◽

Vol 65 (7) ◽

pp. 405-410

Author(s):

I. V. Gorbacheva ◽

O. U. Kuznetsova ◽

F. N. Gilmiyarova ◽

D. V. Pechkurov ◽

L. N. Vinogradova

Keyword(s):

Preterm Infants ◽

Gestational Age ◽

Protein Energy Malnutrition ◽

Transferrin Saturation ◽

Deficiency Anemia ◽

First Year ◽

Content Increase ◽

Term Infants ◽

Protein Energy ◽

First Year Of Life

Comparative analysis of energy-plastic exchange indicators in mature and premature children of the first year of life in the development of protein-energy malnutrition (PEM) was carried out. Unidirectional changes are revealed, including an increase in creatinine, lactate and creatine phosphokinase activity levels, suggesting a n increasing muscle mass deficit against the background of glucose anaerobic oxidation activation. In preterm infants, glucose and triacylglicerine levels decrease, which reflects uncompensated insufficiency of energy substrates and, accordingly, ATP level. Multidirectional deviations in metabolism are pyruvate and ATP content: increase in full-term infants and decrease in preterm infants, that should be taken into account when monitoring condition of children with PEM. A significant decrease of pyruvic acid in preterm infants against the background of the levels of total protein, albumin, hemoglobin, and transferrin, not exceeding reference values, can obviously testify to the active use of this integral metabolite to maintain the fund of substituted amino acids. Development of this pathology in both mature and premature infants creates a pre-morbid background for iron deficiency anemia-diagnostic panel, which should be supplemented by calculation of transferrin saturation coefficient. Regardless of gestational age in childbirth during the formation of PEM, the lipid spectrum is rearranged according to atherogenic type: at normal values of total cholesterol, there is a significant increase in low and very low density lipoproteins with an increase in the atherogenicity coefficient. This singles out children with the pathology in question as a risk group for the development of the atherosclerotic process later, which justifies the recommendation to control the lipid profile in children of the first year of life.

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Immune-related adverse events in advanced NSCLC treated with immunotherapy alone or concurrent chemotherapy and immunotherapy.

Journal of Clinical Oncology ◽

10.1200/jco.2019.37.8_suppl.83 ◽

2019 ◽

Vol 37 (8_suppl) ◽

pp. 83-83

Author(s):

John Melson ◽

Daniel Reed ◽

Bethany J. Horton ◽

Margaret Moore ◽

Jacqueline Theresa Brown ◽

...

Keyword(s):

Adverse Events ◽

Proportional Hazards ◽

Advanced Nsclc ◽

Checkpoint Inhibitors ◽

Therapy Group ◽

Stage Iv ◽

Standard Of Care ◽

Concurrent Chemotherapy ◽

Increased Risk ◽

Treatment Naïve

83 Background: Concurrent chemotherapy (CTX) with checkpoint inhibitors (CPI) has become a new standard of care for treatment naïve stage IV non-small cell lung cancer (NSCLC). Little is known about the timing and pattern of immune-related adverse events (irAEs) when CTX and CPI are combined. We sought to characterize irAEs and determine if combination CTX+CPI affects time to first irAE in comparison to patients (pts) receiving CPI alone. Methods: Advanced NSCLC patients who received at least one dose of a CPI at our institution between 2015 and 2018, either alone or with CTX, were identified. Retrospective review for occurrence of irAEs and clinical outcomes was performed. Proportional hazards models were used to assess time to first irAE for CPI vs CTX+CPI and overall survival (OS) for CPI alone. Results: 149 pts were identified. 112 pts received CPI alone and 37 received CTX+CPI. The proportion of pts with at least 1 irAE was higher in the combination therapy group than the monotherapy group (59% vs 34% of patients). Time to any grade first irAE was shorter with CTX+CPI vs CPI alone (6.0 m vs 36.7 m, HR 1.8, p = 0.0304). Among pts treated with CPI alone, OS was significantly longer with any irAE (38.0 m vs 11.4 m, HR 2.9, p = 0.0026). While there were more irAEs in the CTX+CPI cohort, the frequency of irAEs by organ system was similar to previous reports. Conclusions: For patients receiving CTX+CPI, there is an increased risk of irAEs and a significantly shorter time to first irAE occurrence compared to CPI alone. Among patients receiving CPI alone, the presence of irAE was associated with a 3-fold improvement in OS. Further analysis of OS for the CTX+CPI group is planned with additional follow-up. [Table: see text]

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