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A Nationally Representative Sample

Diane L. Langkamp, MD, MPH; Stacy Hoshaw-Woodard, PhD; Mark E. Boye, MS, MBA, MPH; Stanley Lemeshow, PhD

Arch Pediatr Adolesc Med. 2001;155:167-172.

Background  Studies of very low-birth-weight (VLBW) children discharged from neonatal intensive care units have shown delays in receipt of routine childhood immunizations. However, a recent study of VLBW children in 3 health maintenance organizations found no significant delays in immunizations.

Objective  To assess the risk of immunization delays for moderately low-birth-weight (MLBW; 1500 g-2499 g) and VLBW (<1500 g) children compared with normal-birth-weight children in a nationally representative birth sample.

Design  Logistic regression analysis using the 1988 National Maternal and Infant Health Survey and the 1991 Longitudinal Follow-up Survey.

Setting  Nationally representative sample of children born in 1988 in the United States.

Participants  A total of 8285 children whose mothers completed both surveys.

Main Outcome Measures  Age at receipt of each of the first 4 doses of diphtheria and tetanus toxoids and pertussis vaccine, the first 3 doses of polio vaccine, and the first dose of measles-mumps-rubella vaccine for MLBW and VLBW children, and normal-birth-weight children. We also examined whether children were up-to-date for all immunizations at ages 12, 24, and 36 months based on birth-weight groups.

Results  Very low-birth-weight children received their first 3 doses of diphtheria and tetanus toxoids and pertussis vaccine and their first 2 doses of polio vaccine significantly later than normal-birth-weight children (P <.001). Very low-birth-weight children were significantly less likely to be up to date for all immunizations at ages 12 months (odds ratio [OR] = .556; P = .001), 24 months (OR = .439; P <.001), and 36 months (OR = .446; P <.001) compared with normal-birth-weight children.

Conclusion  Very low-birth-weight children are at risk for immunization delays compared with normal-birth-weight children.

From the Department of Pediatrics (Dr Langkamp), the Biostatistics Program (Drs Hoshaw-Woodard and Lemeshow), and the College of Pharmacy (Mr Boye), Ohio State University, Columbus.

Corresponding author: Diane L. Langkamp, MD, MPH, Children's Hospital, Room H310, 700 Children's Dr, Columbus, OH 43205 (e-mail: dlangkam{at}chi.osu.edu).

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