Effectiveness of the 10-valent pneumococcal conjugate vaccine among girls, boys, preterm and low-birth-weight infants – Results from a randomized, double-blind vaccine trial
Heta NieminenHanna Rinta‐KokkoJanne J. JokinenTaneli PuumalainenMarta MoreiraDorota BorysLode SchuermanArto A. Palmu
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Abstract:
Several studies have shown differences in susceptibility to infections and immune response to vaccines by sex. Prematurely born infants are at higher risk for pneumococcal diseases, with lower effectiveness for some vaccines compared to term infants. We have reported the effectiveness of the 10-valent pneumococcal non-typeable Haemophilus influenzae protein D conjugate vaccine (PHiD-CV10) on several endpoints in the Finnish Invasive Pneumococcal disease (FinIP) vaccine trial. Now, we present the results of a post-hoc analysis evaluating PHiD-CV10 effectiveness in subgroups by sex, gestational age, and birth weight. The FinIP trial was a phase III/IV cluster-randomized, double-blind trial. Infants enrolled < 7 months of age received PHiD-CV10 in two thirds of clusters (3 + 1 or 2 + 1 schedule) and hepatitis B vaccine as control in remaining third. Outcome data included invasive pneumococcal disease, pneumonia, tympanostomy tube placements, and antimicrobial purchases collected through national, routinely used health registers. Negative binomial model was used in the incidence and vaccine effectiveness estimation, and differences in incidences between subgroups were tested among control children. Of the 30,527 infants enrolled 51% were boys. The incidences of hospital-diagnosed pneumonia and otitis-related outcomes were higher among boys in control groups. There were no significant sex differences in the vaccine effectiveness estimates. Altogether, 1519 (5%) infants were born before 37th gestational week. The incidences of pneumonia outcomes were higher among premature infants when compared to term infants. The vaccine effectiveness estimates among preterm infants were not statistically significant except for antimicrobial purchases, but all point estimates were at the same level among preterm infants as among term infants. There was no significant difference between 2 + 1 and 3 + 1 schedules in any of the subgroups analysed. PHiD-CV10 had a similar effectiveness in both sexes, and seemed to be protective in preterm infants. Trial registration: ClinicalTrials.gov NCT00861380 and NCT00839254Keywords:
Pneumococcal Conjugate Vaccine
Aims: To determine the serum ferritin levels amongst low birth weight neonates and to correlate it with different categories of low birth weight. To determine the role of birth weight in predicting changes in serum ferritin levels.
Methodology: This was a prospective comparative cross sectional study which was carried out at the Neonatal Intensive Care Unit of the University of Nigeria Teaching Hospital (UNTH), Enugu, Nigeria between June and December 2014. The study included 140 newborns of all birth weights delivered at the UNTH. These were categorized into extremely low birth weight (ELBW), very low birth weight (VLBW), low birth weight (LBW) normal birth weight and macrosomic. Babies with C-reactive protein levels > 10mg/dl, who were intra-uterine growth restricted, and whose mothers had conditions associated with low iron stores were excluded from the study. Anthropometric measurements were done for all subjects. Serum ferritin was measured at birth and this was correlated with birth weight and gestational age.
Results: Serum ferritin levels ranged from 20.6 to 296.4µg/l. Ferritin levels showed a steady increase in relation to birth weight. (F = 42.453, P < .001). There was a significant association between ferritin levels and categories of birth weight. ELBW babies were 98 times more likely to have low ferritin levels than babies with normal weight (P < .001, OR = 97.600, 95% C.I = 10.083 – 944.711). VLBW and LBW babies were more likely to have low ferritin levels than babies with normal weight (P < .001, OR = 0.070, 95% C.I = 0.017 – 0.291)(P = .006, OR = 0.201, 95% C.I = 0.064 – 0.635). Only birthweight was a significant positive predictor of low ferritin levels (P = .024).
Conclusion: Serum ferritin in new-borns showed a significant association with birth weight. Birth weight is a positive predictor of low serum ferritin levels.
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The psychological development of 18-month-old children born with very-low-birth-weight (N=10) and extremely-low-birth-weight (N=8) was compared by using the Kyoto Scale of Psychological Development. Children with extremely-low-birth-weight showed significantly lower total DQ than children with very-low-birth-weight (p<.01).Cognitive-Adaptive DQ (p<.01) and Language-Social DQ (p<.01) in children with extremely-low-birth-weight were lower than in children with very-low-birth-weight. Among the children with extremely-low-birth-weight, the DQ of both the Cognitive-Adaptive Area and the Language-Social Area were significantly lower than the Postural-Motor Area (p<.01). These results revealed severe developmental retardation and unbalanced developmental characteristics in 18-month-old children born with extremely-low-birth-weight, whereas the children who had had very-low-birth-weight showed no significant differences among their DQ in 3 different areas, even though corrected age was used.
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Objective: To investigate the characteristics and associated factors of early refractive parameters in premature infants. Methods: Case-control study. Premature infants who underwent the first fundus screening in the ophthalmic clinic of Xiamen children's Hospital from May 2018 to February 2019 were collected. The screening time was 4 to 6 weeks after birth or corrected gestational age from 31 to 32 weeks. The premature infants who were diagnosed with mild retinopathy of prematurity (ROP) in one eye or both eyes but did not receive any treatment were divided into ROP group and divided into zone Ⅱ subgroup and zone Ⅲ subgroup according to the region of ROP; the premature infants without ROP were divided into non-ROP group. The gestational age, birth weight, spherical equivalent, anterior chamber depth, vitreous depth, axial length, lens thickness and corneal refractive power were recorded and compared. Independent sample t-test, multiple linear regression analysis and Pearson correlation analysis were used. Results: A total of 180 premature infants, 101 males and 79 females, with gestational age of (30.82±3.10) weeks, corrected gestational age of (37.21±1.44) weeks and birth weight of (1 577.85±572.12) g were included in this study. Ninety premature infants were included in the ROP group (162 eyes, of which 85 right eyes were included in the analysis) and 90 in the non-ROP group (90 right eyes). There was no significant difference in the distribution of gestational age, birth weight and corrected gestational age between the ROP group and non-ROP group (all P>0.05), but there was significant difference in the spherical equivalent between the two groups [(1.90±1.39) D vs. (3.04±1.88) D, t=-4.653, P<0.01], and ROP group was relatively smaller. In the ROP group, the anterior chamber depth was (1.82±0.23) mm, the lens thickness was (4.54±0.18) mm, and the corneal refractive power was (43.99±0.99) D. In the non-ROP group, the anterior chamber depth was (1.91±0.94) mm, the lens thickness was (4.23±0.50) mm, and the corneal refractive power was (43.72±0.92) D. The difference between the two groups was statistically significant (all P<0.01). In ROP group, the anterior chamber depth was shallower, the lens was thicker, and the corneal refractive power was higher. In ROP group, the corneal refractive power of 48 right eyes in zone Ⅱ subgroup and 37 right eyes in Zone Ⅲ subgroup were (43.92±0.78) D and (43.39±1.05) D respectively, and the spherical equivalent were (2.08±0.95) D and (2.52±1.12) D respectively. The corneal refractive power of zone Ⅱ subgroup was higher and the spherical equivalent was smaller, and the differences were statistically significant (all P<0.05). Multiple regression analysis showed that birth weight, gestational age and corneal refractive power were the influencing factors of spherical equivalent (P<0.01). The results of Pearson correlation analysis showed that the gestational age (r=0.182), birth weight (r=0.223) and corneal refractive power (r=-0.125) of premature infants were closely related to the spherical equivalent (all P<0.05). Conclusions: In premature infants, the larger spherical equivalent is related to greater gestational age and heavier birth weight. The refractive parameters of mild ROP are characterized by shallow anterior chamber, thick lens, high corneal refractive power and small spherical equivalent. The spherical equivalent is closely related to the development of ROP. (Chin J Ophthalmol, 2021, 57: 353-357).
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Prospective observational study was conducted in a tertiary care hospital of India over 8 months to measure blood pressure (BP) in healthy term and preterm neonates using oscillometric method and explore the associations with gestational age and birth weight. Consecutive BP measurements were taken by standard oscillometric method on 1617 neonates on day 4, 7 and 14 of life. Mean birth weight was 2.7 ± 0.46 kg, and mean gestational age was 38.2 ± 2.12 weeks. The mean arterial pressure (MAP) on day 4, 7 and 14 were 59.3 ± 7.33, 63.2 ± 6.55 and 66.4 ± 6.13 mmHg, respectively. Larger and mature newborns had significantly higher BP than those who were smaller and premature. Birth weight more strongly correlated with MAP than gestational age. Predictive equations linking MAP with gestational age and birth weight were deduced, which can be used for judicious fluid inotrope management.
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Prevalence of low birth weight deliveries may vary across different environments. The necessity of determination of regional data prompted this study.Information of all deliveries from January 2004 to December 2008 was obtained from delivery registry records retrospectively. Initial data including birth weight, vital status, sex, maternal age and mode of delivery were recorded using medical files. The frequency of low birth weight, very low birth weight, extremely low birth weight and stillbirth deliveries were determined.Among 19,533 total births, there were 450 (23.04 per 1000) stillbirths. Low birth weight rate was 10.61%. A significant increase in yearly distribution of low birth weight deliveries was observed (P<0.001). Very low birth weight and extremely low birth weight delivery rates were 3.14% and 1.58% respectively. Among 2073 low birth weight infants, 333 (16.06%) were stillbirths. The stillbirth delivery rate and the birth of a female infant among low birth weight deliveries were significantly higher than infants with birth weight ≥2500g (P<0.001, OR=28.37), (P<0.001) retrospectively. There was no statistical difference between low birth weight and maternal age. The rate of cesarean section among low birth weight infants was 49.4%.High low birth weight and stillbirth rates, as well as the increase in low birth weight deliveries over the past five years in this study are striking. For reduction of increased low birth weight rates, appropriate intervention methods should be initiated.
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Survival rates specific for birth weight, gestational age, sex, and race are described for 6676 inborn neonates who weighed less than 1251 g at birth and were born during 1986 through 1987. Overall 28-day survival increased with gestational age and birth weight, from 36.5% at 24 weeks' gestation to 89.9% at 29 weeks' gestation, or from 30.0% for neonates of 500 through 599 g birth weight to 91.3% for neonates of 1200 through 1250 g. The expected birth weight-specific survival advantage for female neonates and black neonates diminished when the data were controlled for gestational age, showing that certain previously reported survival advantages are based on lower birth weight for a given gestational age. Multivariate analysis showed that all tested variables were significant predictors for survival, in order of descending significance: gestational age and birth weight, sex, race, single birth, and small-for-gestational-age status. The powerful effect of gestational age on survival highlights the need for an accurate neonatal tool to assess the gestational age of very low birth weight neonates after birth.
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Birth weight is the first weight of the new born obtained immediately after birth with in the first hour of life before significant weight loss occurred after birth [1]. World Health Organization (WHO) classified birth weight as macrosomia, normal birth weight (NBW) and low birth weight (LBW). Low birth weight is defined as having a birth weight of less than 2500 g regardless of gestational age and is further classified as very low birth weight (VLBW), a new-born birth weight less than 1500 g and extremely low birth weight (ELBW) is a neonate having birth weight less than 1000 g at birth regardless gestational age [2]. Globally over the last twenty years the world made extensive progress in reducing mortality among less than 28 days aged children. Despite progress over the past two decades, in 2017 alone, 2.5 millions of neonates died, due to low birth weight, prematurity and other preventable causes of neonatal death [3]. Child who have Low birth weight children have immature immune function are also prone to have increased risk of disease, lower IQ and cognitive disabilities which could affect their performance in schoo
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