Abstract 3275: Should Routine Immunizations Be Deferred in Infants with Single Ventricle?
Infants with single ventricle congenital heart defects are at risk for sudden unexpected death. There have been anecdotal reports of acute decompensation following routine immunizations in this population. In an effort to decrease the risk of sudden death some centers have advocated that routine immunizations be deferred in these children. However, it is not known if a true association between immunizations and adverse events exists. In the present study we examined the relationship of newborn immunizations to adverse events, which were defined as death or hospital readmission . Diptheria/tetanus/acelluar pertussis (DTaP) vaccine and/or hepatitis B vaccine, but not Palivizumab prophylaxis, was considered in analysis. The patient population consisted of infants with functional single ventricle less than 6 months of age who resided locally and who had not yet undergone bidirectional Glenn surgery. Immunization data were obtained from a mandatory statewide database. A fixed-effect model was employed to analyze for a temporal assocation between immunizations and adverse events. Our institution employs a routine home surveillance strategy for infants with single ventricle that includes regular nursing visits.
Results: Over a 38 month period there were 101 subjects with single ventricle discharged to home. The most common diagnoses were: Hypoplastic left heart syndrome (HLHS) n=42, pulmonary atresia/intact ventricular septum n=13, and heterotaxy & atrioventricular canal n=10. The majority of HLHS patients (93%) had Norwood palliation with a right ventricle to pulmonary artery conduit. In the entire cohort there were 2 sudden death events and 109 readmissions. The most common indications for readmission were: enteritis/dehydration (22%), hypoxemia (16%) & fever/viral syndrome (16%). Immunization within 48 hours was not significantly associated with adverse events, OR=0.87, 95% CI 0.11–5.76, p=0.87. Infants with HLHS had similar rates of adverse events as non-HLHS patients, OR=0.94, 95% CI 0.37–2.42, p=0.88.
Conclusions: No association could be identified between routine immunizations and adverse infants in infants with single ventricle. As such, the proposal to alter the immunization regimen in this population does not appear justified.