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DURHAM, N.C. – Hospitalized premature infants who received recommended two-month vaccinations had an increased risk of a short episode of apnea, but no serious complications arose, according to a study led by Duke Health researchers.

Appearing Jan. 6 in the journal JAMA Pediatrics, the study confirms previous findings linking apnea, which is a pause in breathing, to vaccinations among premature babies; the potential side effect had been observed in some previous studies and is among those already identified on package inserts for several childhood vaccines. This study confirms the risk for apnea in the 48 hours following vaccination for hospitalized premature infants.

“While there is a temporary increased risk of apnea after vaccination, the risk posed by vaccine-preventable respiratory and other infections to unvaccinated infants is far higher,” said lead author Rachel G. Greenberg, M.D., associate professor in the Department of Pediatrics at Duke University School of Medicine.

Greenberg noted that hospitalized premature infants have weak immune systems that make them more vulnerable to illnesses, and they have pre-existing conditions that complicate their care when they become sick. As a result, preterm babies have higher rates of severe illness for illnesses such as pertussis and pneumonia than term infants.

“Also, the episodes of apnea after vaccination in our study of hospitalized premature infants were brief and without serious complications,” Greenberg said. “As a result, our study supports that the current vaccination recommendations for premature infants are appropriate, but it’s important to educate parents about what to expect when their premature infants receive vaccines while in the hospital.”

Greenberg and colleagues enrolled 223 hospitalized premature infants who were born before 33 weeks gestation. At two months of age, roughly half the babies were randomly assigned to receive the first recommended dose of childhood vaccines that protect against pneumonia, diphtheria, tetanus, pertussis, hepatitis B, polio and meningitis. The remaining babies did not receive vaccines for two days, after which they were allowed to receive vaccines as part of routine care.

All the infants were observed for apnea for 48 hours after vaccination or randomization for the unvaccinated group. The infants who received the vaccines were more likely to have an apnea episode in the monitoring period than the unvaccinated babies. The odds of having an episode of apnea were 2.7 times higher in the vaccinated group during the 48-hour monitoring period.

Apnea episodes were brief, lasting an average of 28 seconds in the vaccination group and 32 seconds in the unvaccinated group.

“The increased risk of brief apnea following vaccination must be weighed against the benefits of timely vaccination,” the study authors wrote. “Premature infants are at increased risk for vaccine-preventable diseases, such as pertussis (whooping cough), which itself is associated with apnea, as well as invasive pneumococcal disease that can cause meningitis and bloodstream infections.”

In addition to Greenberg, study authors include Wes Rountree, Mary Allen Staat, Elizabeth P. Schlaudecker, Brenda Poindexter, Andrea Trembath, Matthew Laughon, Marek S. Poniewierski, Rachel L. Spreng, Karen R. Broder, A. Patricia Wodi, Oidda Museru, E. Gloria Anyalechi, Paige L. Marquez, Emily A. Randolph, Samia Aleem, Ryan Kilpatrick, and Emmanuel B. Walter.

The study received funding support from the Centers for Disease Control and Prevention (contracts 200-2012-53663/0010 and 200-2012-53661/0007).