JAMA Original Investigation | June 01, 2015
Adverse Events After Routine Immunization of Extremely Low-Birth-Weight Infants FREE ONLINE FIRST
Stephen D. DeMeo, DO1; Sudha R. Raman, PhD2; Christoph P. Hornik, MD, MPH1,2; Catherine C. Wilson, DNP, NNP-BC, FNP-BC3; Reese Clark, MD4; P. Brian Smith, MD, MPH, MHS1,2
[+] Author Affiliations
JAMA Pediatr. Published online June 01, 2015. doi:10.1001/jamapediatrics.2015.0418
Importance Immunization of extremely low-birth-weight (ELBW) infants in the neonatal intensive care unit (NICU) is associated with adverse events, including fever and apnea or bradycardia, in the immediate postimmunization period. These adverse events present a diagnostic dilemma for physicians, leading to the potential for immunization delay and sepsis evaluations.
Objective To compare the incidence of sepsis evaluations, need for increased respiratory support, intubation, seizures, and death among immunized ELBW infants in the 3 days before and after immunization.
Design, Setting, and Participants In this multicenter retrospective cohort study, we studied 13 926 ELBW infants born at 28 weeks’ gestation or less who were discharged from January 1, 2007, through December 31, 2012, from 348 NICUs managed by the Pediatrix Medical Group.
Exposures At least one immunization between the ages of 53 and 110 days.
Main Outcomes and Measures Incidence of sepsis evaluations, need for increased respiratory support, intubation, seizures, and death.
Results Most of the 13 926 infants (91.2%) received 3 or more immunizations. The incidence of sepsis evaluations increased from 5.4 per 1000 patient-days in the preimmunization period to 19.3 per 1000 patient-days in the postimmunization period (adjusted rate ratio [ARR], 3.7; 95% CI, 3.2-4.4). The need for increased respiratory support increased from 6.6 per 1000 patient-days in the preimmunization period to 14.0 per 1000 patient-days in the postimmunization period (ARR, 2.1; 95% CI, 1.9-2.5), and intubation increased from 2.0 per 1000 patient-days to 3.6 per 1000 patient-days (ARR, 1.7; 95% CI, 1.3-2.2). The postimmunization incidence of adverse events was similar across immunization types, including combination vaccines when compared with single-dose vaccines. Infants who were born at 23 to 24 weeks’ gestation had a higher risk of sepsis evaluation and intubation after immunization. A prior history of sepsis was associated with higher risk of sepsis evaluation after immunization.
This video is timely and a valuable resource for birth workers. It’s a good length (20 mins) and it addresses that large number of women who are not ready for a home birth for a VBAC. It’s also a very good promotion for hiring a doula. Chileshe Nkonde-Price, a cardiologist at the University of Pennsylvania, wants to avoid an unnecessary Cesarean. This is the last week of her pregnancy. Enjoy and tell me what you think of it. Gloria
An Unnecessary Cut? How the C-section Became America’s Most Common Major Surgery – The New Yorker
From Melissa: ” Here’s my birth montage of our baby number four Marlia. Three years ago I gave birth to Blaze our third baby at home and you posted his slide show on your blog. The only thing I regretted about his birth was not having any video footage of his birth. I have included some footage of Marlia’s birth in the slide show. I had a midwife present for Marlia’s birth and as last time she stood back and just took photos for me. I transferred to hospital for postnatal care as my husband and I are now separated and I had no one to care for me at home. We transferred via ambulance skin on skin with cord still intact and pulsating and it continued for 1.5 hours post birth. I birth the placenta in the shower at hospital 2hrs after the birth with no pressure from the staff. The hospital were very good about all of my postnatal wishes. “
Read Gina’s story on her blog at http://www.trulypurebirth.com/jaxon_hypnobabies_birth_story.html Quote from the story that I love: “It was the most amazing feeling reaching down, catching our baby and bringing him to my chest. No one other than Cody and I touched our baby, that was very special to me. He snuggled on my chest and Cody told me how proud he was of me and I told Jaxon how proud I was of him.”
I’ve been on a bit of a rant lately about “Keep those damn hats off babies”, “Take off those wet sports bras”, “Get everyone skin-to-skin, dark, private” and I get told that “We have to choose our battles”, “It’s important to meet people where they are and not overwhelm them with picky details”, and other variations of advice to STOP IT!
These things are HUUUUUGE to me. I only want to speak into the ears of those who want perfect births. I had a perfect birth. What is a perfect birth? It’s a birth that you look back on when your child is 30 years old and you wouldn’t change a single thing about it. . . every smell, touch, taste, word spoken and beam of light goes to the grave with you as a top of the mountain of life experience. It’s an experience that makes up for so much of the day to day b.s. that is part of living in a human body. It helps to salve the losses and the heartaches and gives you a glimpse of the bliss that’s possible when all the stars align on a really, really good day. That’s what I want for every birthing woman. When I saw this little video clip (I think it’s from Russia), it made my heart sing as I prayed that no one would enter the frame and interfere with this woman’s bliss (no one does). Unfortunately the sound is missing but I love it that someone turns off the lights so baby could transition to this bright world in a slow way. I also love it that the toddler comes in with questioning eyes to see what the heck is happening in his world and looks to the Dad with questioning eyes and is reassured that “Yes, this is different but it’s all good, sweetie.” I just made that up but I love my own version of things. Enjoy.