TY - JOUR
T1 - Mortality risk among frail neonates might be associated with maternal BCG scar status
T2 - Observational study from Guinea-Bissau
AU - Schaltz-Buchholzer, Frederik
AU - Aaby, Peter
AU - Silva, Isaquel
AU - Monteiro, Ivan
AU - Kollmann, Tobias R
AU - Amenyogbe, Nelly
AU - Bjerregaard-Andersen, Morten
AU - Benn, Christine Stabell
N1 - © The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America and HIV Medicine Association.
PY - 2022/4/13
Y1 - 2022/4/13
N2 - BACKGROUND: Maternal priming with Bacille Calmette-Guérin (BCG) has been associated with reduced offspring mortality. We investigated this association in a cohort of frail neonates.METHODS: We performed an observational study within a randomized BCG trial conducted at the Neonatal Intensive Care Unit (NICU) in Guinea-Bissau from 2015-2017. At NICU admission and following informed consent, the maternal scar status was evaluated by visual inspection before neonates were randomized 1:1 to receive BCG + Oral Polio Vaccine (OPV) immediately versus BCG + OPV at hospital discharge. Stratified by maternal scar status, we assessed overall in-hospital and post-discharge mortality up to 42 days of age in Cox Proportional Hazards models providing adjusted Mortality Rate Ratios (aMRRs).RESULTS: 62% (903/1451) of mothers had a BCG scar. During NICU admission, the mortality risk was 1.7% (15/903) for neonates born to mothers with a scar vs 3.3% (18/548) for those born to mothers with no scar, the maternal scar/no scar aMRR = 0.53 (0.26-1.05); the aMRR was 0.39 (0.13-1.05) for unvaccinated neonates and 0.70 (0.26-1.87) for vaccinated neonates.CONCLUSION: This small study indicates that maternal BCG might be associated with reduced all-cause NICU mortality. If confirmed elsewhere, this finding would have substantial ramifications for global health.
AB - BACKGROUND: Maternal priming with Bacille Calmette-Guérin (BCG) has been associated with reduced offspring mortality. We investigated this association in a cohort of frail neonates.METHODS: We performed an observational study within a randomized BCG trial conducted at the Neonatal Intensive Care Unit (NICU) in Guinea-Bissau from 2015-2017. At NICU admission and following informed consent, the maternal scar status was evaluated by visual inspection before neonates were randomized 1:1 to receive BCG + Oral Polio Vaccine (OPV) immediately versus BCG + OPV at hospital discharge. Stratified by maternal scar status, we assessed overall in-hospital and post-discharge mortality up to 42 days of age in Cox Proportional Hazards models providing adjusted Mortality Rate Ratios (aMRRs).RESULTS: 62% (903/1451) of mothers had a BCG scar. During NICU admission, the mortality risk was 1.7% (15/903) for neonates born to mothers with a scar vs 3.3% (18/548) for those born to mothers with no scar, the maternal scar/no scar aMRR = 0.53 (0.26-1.05); the aMRR was 0.39 (0.13-1.05) for unvaccinated neonates and 0.70 (0.26-1.87) for vaccinated neonates.CONCLUSION: This small study indicates that maternal BCG might be associated with reduced all-cause NICU mortality. If confirmed elsewhere, this finding would have substantial ramifications for global health.
U2 - 10.1093/infdis/jiac140
DO - 10.1093/infdis/jiac140
M3 - Journal article
C2 - 35417538
JO - Journal of Infectious Diseases
JF - Journal of Infectious Diseases
SN - 0022-1899
ER -