Published online October 1, 2004
PEDIATRICS Vol. 114 No. 4 October 2004, pp. 1127-1128 (doi:10.1542/10.1542/peds.2004-1026)
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Immunization Responses in Preterm Infants Who Receive Postnatal Steroid Treatment

Janet Berrington, MRCP
Alan Fenton, MD
Department of Neonatology
Royal Victoria Infirmary
Newcastle on Tyne NE1 4LP, England

To the Editor.—

In their recent Pediatrics article, Robinson et al1 suggest that receipt of postnatal steroids impairs antibody response to tetanus and diphtheria immunization, having previously asserted the same for Haemophilus influenzae type b (Hib).2 Although postnatal steroid use has declined, it remains an important issue for neonatologists. Robinson et al conclude this after the demonstration of lower postimmunization geometric mean titers in their own population of preterm infants who received postnatal steroids in comparison to their own population who did not. However, the authors fail to address the fact that the geometric mean titers to both tetanus and Hib in their nonsteroid preterm population are significantly higher than in any other United Kingdom preterm cohort (Table 1).


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  		TABLE 1. Comparison of United Kingdom Preterm Infant Immunization Responses

 
If this unusually responsive cohort is the comparator for the steroid-treated group, then it would seem that postnatal steroids impair response. However, comparison to other authors' data would suggest that Robinson et al, in fact, did not have a group of poor responders in their steroid-treated group but had unusually good responders in their (small) non–steroid-treated group.

Do the authors have an explanation for their "control" group's responses? Could it relate to the now well-recognized effects on immunogenicity of coadministered vaccines, an issue not discussed for the study infants?

REFERENCES

  1. Robinson M, Heal C, Gardener E, Powell P, Sims D. Antibody response to diphtheria-tetanus-pertussis immunization in preterm infants who receive dexamethasone for chronic lung disease. Pediatrics. 2004;113 :733 –737[Abstract/Free Full Text]
  2. Robinson MJ, Campbell F, Powell P, Sims D, Thornton C. Antibody response to accelerated Hib immunisation in preterm infants receiving dexamethasone for chronic lung disease. Arch Dis Child Fetal Neonatal Ed. 1999;80 :F69 –F71[Abstract/Free Full Text]
  3. Slack MH, Schapira D, Thwaites RJ, et al. Immune response of premature infants to meningococcal serogroup C and combined diphtheria-tetanus toxoids-acellular pertussis-Haemophilus influenzae type b conjugate vaccines. J Infect Dis. 2001;184 :1617 –1620[CrossRef][Web of Science][Medline]
  4. Slack M, Schapira D, Thwaites RJ, et al. Acellular pertussis vaccine given by accelerated schedule: response of preterm infants. Arch Dis Child Fetal Neonatal Ed. 2004;89 :F57 –F60[Abstract/Free Full Text]
  5. Ramsay ME, Miller E, Ashworth LA, Coleman TJ, Rush M, Waight PA. Adverse events and antibody response to accelerated immunisation in term and preterm infants. Arch Dis Child. 1995;72 :230 –232[Abstract/Free Full Text]
PEDIATRICS (ISSN 1098-4275). ©2004 by the American Academy of Pediatrics

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This Article
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Google Scholar
Right arrow Articles by Berrington, J.
Right arrow Articles by Fenton, A.
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PubMed
Right arrow PubMed Citation
Right arrow Articles by Berrington, J.
Right arrow Articles by Fenton, A.
Related Collections
Right arrow Infectious Disease & Immunity
Right arrowRelated AAP Red Book topics:
Haemophilus influenzae Infections
Diphtheria
Tetanus (Lockjaw)
Social Bookmarking
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