Same shot, same schedule: Vaccination equality for preterm and full-term infants


Despite being widely recommended, immunisation of preterm infants is frequently delayed, exposing this vulnerable group to various preventable diseases. The review article “An update on vaccination in preterm infants” by Lillian de Santos Rodrigues Sadeck and Renato de Ávila Kfouri delves into recent research on vaccine safety, effectiveness, and immunogenicity in preterm infants, shining a light on the importance of timely vaccination.  Preterm infants more at risk for preventable illnesses Compared to full-term infants, preterm infants face increased susceptibility to morbidity and mortality caused by vaccine-preventable diseases. This heightened vulnerability is primarily linked to their underdeveloped immune system, which has not fully matured yet and is not fully functional. Additionally, the transfer of maternal antibodies through the placenta begins around the 17th to 18th week of gestation, gradually increasing and reaching peak levels with greater gestational age at birth. Consequently, antibody levels are lower in preterm infants, leaving them more vulnerable to infections.  Prolonged hospitalisation in the Neonatal Intensive Care Unit (NICU) poses additional risks. Infants are exposed to resistant pathogens and administered broad-spectrum antibiotics or steroids. Additionally, they often experience a lack of breastfeeding and disruption of protective barriers due to invasive medical procedures. Reasons for delayed vaccinations  Research indicates that preterm infants frequently encounter delays in their vaccination schedules, particularly those with lower gestational age and birth weight. These delays stem from concerns surrounding their vulnerability and the development of their immune system as well as apprehensions regarding vaccine safety. This highlights a gap in understanding vaccine safety and effectiveness among healthcare providers and parents, often driven by fear of adverse reactions. While preterm infants may exhibit higher rates of post-vaccination fever and cardiorespiratory events compared to full-term infants, these effects are typically temporary and mild, with no lasting clinical impact. Immunisation just as safe for preterm infants  Several studies have indicated that preterm infants generate an adequate immune response, according to their chronological age, as recommended, for instance by the German Standing Committee on Vaccination (“Ständige Impfkommission” in German, abbreviated as STIKO) and by the American Academy of Pediatrics Committee on Infectious Diseases. While their initial antibody responses may be lower than those of full-term infants, when vaccinated according to chronological age, most reach protective antibody concentrations. Provided they are clinically stable and there are no contraindications, preterm infants should receive vaccines according to the schedule recommended for full-term infants and based on their chronological age.  Given that preterm infants tolerate vaccination well and exhibit protective immune responses, studies have shown that preterm infants undergo unjustified delays in their vaccination schedule. To address this, several actions are necessary: evidence-based education for healthcare professionals,   widespread dissemination in lay-friendly formats for parents and caregivers,  improved access to immunisation, and  administration of vaccines prior to NICU discharge. Education initiatives should stress the importance of chronological age, alongside clinical conditions, in commencing the immunisation process.  Paper available at:   Full list of authors: Lilian dos Santos Rodrigues Sadeck, Renato de Ávila Kfouri.  DOI: 10.1016  Keywords: #PretermBirth #FollowUp #ESCNH #ResearchNews 

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Beyond birth: Insights into emotional wellbeing of mothers after very preterm birth


© Unsplashed Mothers and children share a close bond. Latest research shows just how close this bond is: maternal resilience and the long-term health and developmental trajectories of very preterm (VPT) children show a significant connection. The seminal cross-national study, conducted in 11 European countries by Lena Wohlers et al., furnishes invaluable insights into this connection, demonstrating how carefully designed targeted interventions can bolster maternal coping abilities, thus optimising outcomes for both mothers and their VPT infants.   Differences within countries Among the 2,605 mothers, the mean score of the MHI-5 assessment was 71.3. The mean scores in Sweden (74.5), Denmark (79.4) and the Netherlands (82.3) were higher than the mean of the overall cohort. In contrast, the mean scores in France (65.3) and Poland (63.5) were significantly lower, indicating overall poorer emotional well-being within mothers compared to the northern countries and the score average. Maternal factors associated with low scores Various factors are linked to low emotional wellbeing within mothers. Lower scores were found for non-European born mothers (68.2) compared to native born mothers or mothers born in other European countries (71.7 and 71.6). Furthermore, even lower MHI-5 scores were found in single mothers (66.6) compared to mothers living with a partner (71.9). Mothers with a low educational level (mean 68.9) attained a lower score in comparison to those with a higher educational level (72.2). These mothers represented a vulnerable group within the sample, being at a higher risk for poor mental health. Regarding perinatal and neonatal characteristics, scores were reduced for mothers with one previous delivery (70.3) and even lower for mothers with two or more deliveries (67.5) compared to mothers having their first child (72.6). These results indicate that caring for several children leads to higher stress in mothers when at least of one of them is VPT. Infant components contributing low scores All child’s health and developmental problems at five years of age were associated with a lower MHI-5 score in mothers. Examples for health problems are sensory impairment, cerebral palsy, developmental delay, speech delay, ADHD, autism, and epilepsy. Higher scores were found for mothers with children born at 28-29 weeks of gestation and with a physical or functional abnormality that is present at birth. What about the fathers? As 85% of the respondents of the questionnaire were mothers, the authors decided to shift their attention towards maternal wellbeing. However, they recognised that fathers are also affected by the VPT birth of their children. They advocated for further research on the fathers’ wellbeing. Emotional wellbeing as part of regular check-ups Given the interdependence of maternal emotional wellbeing and child development , assessments of maternal emotional wellbeing should become part of the obstetric, prenatal, and postnatal check-ups, as well as paediatric visits in early childhood. Also, an infant- and family-centred approach can empower both parents to better cope with the situation. Previous research has shown that mothers attending early intervention programs have lower levels of stress. The interventions should meet the individual needs of parents and families in terms of methods, duration, and frequency. The study authors suggest, however, that these interventions commence during the NICU stay and are continued at home to ensure the best possible outcomes for mothers, children, and other caregivers. These findings demonstrate that very preterm birth has a negative influence on maternal and, presumably, paternal emotional well-being at five years after birth. Furthermore, the need for support and interventions for parents of VPT children is highlighted, starting in the NICU, and extending as necessary.   Paper available at: Children | Free Full-Text | Maternal Wellbeing Five Years after a Very Preterm Delivery: Prevalence and Influencing Factors in a European Cohort ( Full list of authors: Lena Wohlers, Rolf Maier, Marina Cuttini, Emilija Wilson, Valérie Benhammou, Jo Lebeer, Sabine Laroche, Iemke Sarrechia, Stavros Petrou, Nicole Thiele, Jennifer Zeitlin, Adrien Aubert. DOI:    

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Unexplored aspects: Improving maternity care through patient-reported outcomes


© Pexels/PNW Production Approximately one-third of women report challenges in their birth experience, along with issues related to healthcare responsiveness and shared decision-making six months postpartum. In the pursuit of comprehensive healthcare quality assessment, traditional clinical indicators often fall short of capturing the nuanced aspects of patient well-being. A retrospective cohort study, conducted by Anouk Klootwijk et al., delves into the transformative potential of patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs) in the realm of pregnancy and childbirth care. By utilizing the International Consortium for Health Outcome Measures (ICHOM) indicator set, the study aims to transform perspectives on quality assessment in maternity care. The study included 645 women and was conducted through an online survey between 2018 and 2019. The focus centred on the women’s experiences six months post-childbirth, capturing PROMs and PREMs at a prominent academic maternity unit in the Netherlands. Regression analysis unravelled associations between these measures, healthcare utilisation, and distinct patient subgroups. Struggles encountered by women giving birth Despite a low 5% dissatisfaction rate with care, the study uncovered suboptimal scores, notably in birth experience (32%) and painful sexual intercourse (42%). Subgroup analyses revealed associations with relevant quality indicators, emphasizing the multifaceted nature of maternity care. Identified subgroups associated with poor scores, such as women in deprived areas and those with a limited social network, had lower birth experience scores. Assisted vaginal delivery was associated with poorer outcomes in health-related quality of life and birth experience. Women with preterm delivery and first-time mothers  had worse scores on multiple PROMs and PREMs compared to women who gave birth at term and multiparous women. For example, preterm birth was linked to insufficient pain relief during labour. This indicates the need for additional attention in terms of pain management in this specific patient group. In addition, about one third of women also reported poor healthcare responsiveness and shared decision-making. Pain during sexual intercourse was conveyed by almost half of all women. There may even be an underestimation in findings due to possible social desirability bias in responses to taboo topics such as incontinency or pain with intercourse. Satisfaction paradox: Suboptimal scores, yet positive feedback Despite these far from optimal scores, women collectively reported good satisfaction with medical care . However, satisfaction with care is more likely to reflect hospitality rather than the actual outcome . Responses are heavily influenced by external factors, including the feeling of personal control, individual expectations, and needs. This highlights the need for a more comprehensive assessment beyond satisfaction scores and indicates the value of more targeted and detailed questionnaires. In conclusion , measuring satisfaction alone is not effective in identifying areas for improving care. PROMs and PREMs offer actionable insights for quality improvement in maternity care and provide a more comprehensive view than traditional clinical outcomes or patient satisfaction scores. The authors emphasize the need for awareness among healthcare professionals regarding persistent pain and sexual health challenges. Training patients and professionals to report, collect, and discuss PROMs and PREMs enables informed shared decision-making.   Paper available at: Patient-reported outcome and experience measures for quality improvement in pregnancy and childbirth care: a retrospective cohort study. BMJ Open Qual. 2023 Mar;12(1):e001922. Full list of authors: Anouk Klootwijk, Pieter Bakx, Arie Franx, Hilmar Bijma, Hiske Ernst-Smelt, Marije Lamain-de Ruiter, Anke Posthumus, Bas van Rijn DOI: 10.1136/bmjoq-2022-001922

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