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QUESTION 2: Vaccinating preterm infants in resource-poor settings: what is the incidence of apnoea, bradycardia and need for respiratory support?
  1. Andrew James McArdle1,
  2. Guy Mugisha2,
  3. Dieudonne Birahinduka3
  1. 1Department of Paediatric Infectious Diseases, Sr Mary's Hospital, London, UK
  2. 2Hôpital Militaire de Kamenge, Bujumbura, Burundi
  3. 3 Department of Paediatrics, Kingston Hospital, London, UK
  1. Correspondence to Dr Andrew James McArdle, Paediatric ST6, St Mary's Hospital, London WC1N 1EH, UK; andrew.mcardle{at}

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A 27-week gestation infant is approaching 2 months of age in a resource-poor hospital with no continuous monitoring or facilities for intubation. WHO guidance advocates vaccinating at 2 months, but you wonder about the possible risks of apnoea and bradycardia.

Structured clinical question

In hospitalised premature infants (population) what is the incidence of apnoea, bradycardia and need for respiratory support (outcome) following routine vaccination (intervention).


A PubMED search for ((‘Infant, Premature’ [Mesh] OR prematur* OR preterm) AND (‘Immunization’ [Mesh] OR ‘Vaccination’ [Mesh] OR Immunisation OR Immunization OR vaccination)) AND (‘Apnea’ [Mesh] OR apnoea OR apnea OR ‘Drug-Related Side Effects and Adverse Reactions’ [Mesh] OR adverse) found 312 articles (13 January 2016). A similar search of EMBASE found 428 articles.

Thirty-four articles provided primary evidence related to adverse events following vaccination in preterm infants, with two obtained through hand-searching references of included studies. Four considered non-routine vaccinations or components, 13 were retrospective and two case series. Of the …

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  • Contributors AJM formulated the clinical question and performed the literature search. DB and GM assisted in data extraction and manuscript preparation.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.