Dell Medical School at the University of Texas at Austin Austin, Texas, United States
Abstract: Background A quarter of children born with congenital heart disease (CHD) will require intervention in the first year of life. This can lead to extended hospitalizations where children may reach ages for recommended childhood vaccinations. Current recommendations generally indicate no need to adjust vaccination schedules for hospitalized children. This study aims to evaluate the rates of children receiving recommended 2-month and 4-month vaccines in the cardiac care unit (CCU) at a single institution.
Methods A retrospective chart review of all patients admitted at < 2 months of age and discharged at >3 months of age (to evaluate 2-month vaccinations) or 5 months (to evaluate both 2-month and 4-month vaccinations) at a single institution’s CCU from 9/1/2018-7/1/2021. Patients were eligible for Diphtheria, tetanus acellular pertussis (DTaP), Haemophilus Influenzae type b (Hib), Pneumococcal conjugate (PCV13), and inactivated poliovirus (IPV) vaccines. Hepatitis B was not evaluated given potential for variability in timing of doses. Additionally Rotavirus was not evaluated as it is not institutional practice to administer while patients are admitted to the hospital. Descriptive and univariate statistics were utilized.
Results A total of 24 eligible patients were identified, where 19(79%) were white, 11(46%) Hispanic, 10(41%) female, and 4(17%) families were non-English speakers. Nine(38%) did not receive all evaluated vaccinations as per guideline schedule with 8(33%) of 2-month doses missing or late and 6(60%) of the 10 eligible 4-month vaccines missing or late. Those missing vaccines were more likely to have a non-cardiac chromosomal abnormality (Table). Median length of stay was longer in those that did not receive recommended vaccinations (163[IQR:126-220] days vs. 109[IQR: 98-152] days and in-hospital mortality was higher (n=2(22.2%) vs. =1(6.7%)), however, neither difference reached statistical significance. No documented reason for missed vaccinations were identified through chart review.
Conclusion More than a third of children admitted to the CCU did not receive recommended 2 and/or 4-month vaccines on schedule. While reasons for missed vaccines were not documented, the missed vaccines may be the result of surgical timing and/or patient instability. Further work is needed to understand reasons for missed vaccines, where possible, implement practices to improve administration of these important vaccinations, and ensure awareness of the post-discharge need for vaccination catch-up.
