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PAGE 2 CONTENTS:

Section II (cont.) Review of Alan Ream Yurko’s Medical Records From the Time of Birth on September 16th, to November 24, 1997, and Analysis of His Health Problems

B. Case history of baby Alan from one week of age to the time of his hospitalization on November 24, 1997
C. Adverse reactions to vaccines in premature and healthy children [click]

Section III. Review of Alan Ream Yurko’s Medical Records During His Hospitalization on November 24 Through 29, 1997, and Analysis of His Health Problems [click]
A. Clinical events and treatments at Princeton hospital

References [click]

II-B. Case history of baby Alan from one week of age to the time of his hospitalization on November 24, 1997
Baby Alan was released from the hospital after one week following his birth with jaundice and respiratory system problems. His mother stated that Alan continued to have symptoms of chest congestion and difficulty in breathing following discharge from the hospital. She observed grunting and raspy breathing patterns with occasional brief periods of apnea. Also, the baby remained grossly jaundiced for a month after returning home, much longer than would have been expected from benign neonatal jaundice [4]. He also showed very slow growth rate in the first four weeks of his life. He gained only 0.5 lb during his first twenty-four days of life (Table 4). Furthermore, review of his doctor’s chart from October 10, 1997 through November 11, 1997 revealed that he suffered from nasal congestion and constipation [16].

His mother stated that the baby developed a high-pitched cry, that his skin became warm to touch, and there was increasing lethargy at about l0 or 11 days following receiving these vaccines (3-4 days prior to his cardiac arrest on November 24, 1997). She had been told by his doctor that he might experience these symptoms, and this led her not to worry about her baby’s symptoms and not to call his doctor [4, 16]. These vaccines have been known to cause serious health problems, especially in premature infants. A detailed description of adverse reactions of vaccines given to baby Alan in premature and healthy children is presented below.

II-C. Adverse reactions to vaccines in premature and healthy children
Serious adverse reactions to the vaccines given to baby Alan (Table 5) that require medical intervention (such as apnea and cardiac problems) are commonly observed in preterm infants. The authors of many well-documented studies concluded that the risk and benefit of vaccination in preterm infants should be evaluated prior to administering the vaccines. They also emphasized that preterm infant who received vaccines should be monitored. The following are descriptions of several selected studies conducted in the USA and other countries to illustrate these points.

(II-C) 1. Case histories of 45 preterm babies who were vaccinated with DTP/Hib (diphtheria, tetanus toxoids, and pertussis/Haemophilus influenzae type B conjugate) in the neonatal intensive care unit of the Royal Gwent Hospital, Newport, UK between January 1993 and December 1998 were studied retrospectively [18]. Apparent adverse events were noted in 17 of 45 (37.8%) babies: 9 (20%) had major events, i.e., apnea, bradycardia or oxygen desaturations, and 8 (17.8%) had minor events, i.e., increased oxygen requirements, temperature instability, poor handling and feeding intolerance. Age at vaccination of 70 days or less was significantly associated with increased risk (p < 0.01). Of 27 babies vaccinated at 70 days or less, 9 (33.3%) developed major events compared with none when vaccinated over 70 d. The authors concluded that vaccine-related cardiorespiratory events are relatively common in preterm babies. Problems were much more common if vaccine is administered at or before 70 d. These babies should therefore be monitored postvaccination. Baby Alan was vaccinated at 57 days of age and sent home without monitoring and medical supervision.

(II-C) 2. Apnea is a respiratory pause of 20 seconds or longer, usually associated with bradycardia, heart rate less than 80 beats/min. After the occurrence of apnea in two preterm infants following immunization with DTP and Hib, Sanchez et al. conducted a prospective surveillance of 97 preterm infants (50 girls, 47 boys) younger than 37 weeks of gestation who were immunized with DTP (94 also received Hib at the same time) in a neonatal intensive care unit in Texas, USA to assess the frequency of adverse reactions, and, in particular, the occurrence of apnea. For each infant, data were recorded for a 3-day period before and after receipt of the immunization [6]. Their study showed that apneic episodes occurred in 34 infants (34%) after immunization. Twelve infants (12% of total) experienced a recurrence of apnea, and 11 (11%) had at least a 50% increase in the number of apneic and bradycardiac episodes in the 72 hours after immunization. This occurred primarily among smaller preterm infants who were immunized at a lower weight (p = 0.01), and who had experienced more severe apnea of prematurity (p = 0.01), and had chronic lung disease (p = 0.03). Some of these infants required new medical intervention for the increased episodes [6].

(II-C) 3. Botham et al. conducted a prospective study of 98 preterm infants (53 males, 45 females), of gestational age 24-31 weeks who were immunized at approximately 2 months postnatal age with diphtheria-tetanus-whole-cell pertussis vaccine (DTPw) in the neonatal intensive care unit (NICU) at King George V Hospital in Sydney, Australia. Half the infants also received Haemophilus influenzae type b conjugate vaccine (Hib) simultaneously. All infants were monitored for apnea and bradycardia in the 24 hr. periods pre- and post-immunization. The study showed that only one infant had apnea and/or bradycardia pre-immunization, compared with 17 post-immunization. For 12 infants these events were brief, self-limiting and not associated with desaturations (oxygen saturation < 90%). However, for five infants (30%), these events were associated with oxygen desaturation, and two of these infants required supplemental oxygen. When considering immunization for preterm infants, the benefits of early immunization must be balanced against the risk of apnea and bradycardia [19].

(II-C) 4. Slack et al., 1999 from the United Kingdom stated that four premature infants developed apneas severe enough to warrant resuscitation after immunization with diphtheria, tetanus, pertussis (DTP), and Haemophilus influenzae B (Hib). One required intubations and ventilation. They also reported that although apneas after immunization are recognized they are not well documented. They concluded that it is time for further research to elucidate the best time to immunize such infants [20].

(II-C) 5. Botham et al. conducted a prospective study of 97 preterm infants who were immunized with diphtheria-tetanus-pertussis to document respiratory and cardiac events [21]. The mean gestational age at birth was 28.1 weeks (range 24-34) and the mean age at immunization was 80.6 days (range 44-257). They found that nineteen (20%) infants developed apnea or bradycardia within 24 h of immunization. The infants who developed apnea and/or bradycardia had a younger gestational age at birth than those who did not (P = 0.03), were artificially ventilated for longer (P = 0.01), and were more likely to have a diagnosis of chronic lung disease (P = 0.006). Two infants who developed concurrent upper respiratory tract infections required additional oxygen, and one of them was treated with oral theophylline. They stated that cardiorespiratory function should be monitored after immunization in very preterm infants who had prolonged ventilatory support and/or chronic lung disease.

Adverse reactions of vaccines that were administered to baby Alan are not limited to preterm infants. They have also been reported in full term infants. Below are brief descriptions of selective studies that describe the incidence of illnesses associated with vaccinations in children. Some of these studies are described in the Physicians’ Desk Reference [17].

1. In the USA, reports to the Vaccine Adverse Event Reporting System (VAERS), concerning infant immunization against pertussis between January 1, 1995 and June 30, 1998 were analyzed. During the study, there were 285 reports involving death, 971 nonfatal serious reports (defined as events involving initial hospitalization, prolongation of hospitalization, life-threatening illness, or permanent disability), and 4,514 less serious reports after immunization with any pertussis-containing vaccine [22].

2. Systemic adverse events occurring within 3 days following vaccination of 4,696 Italian infants with DTP at 2, 4, and 6 months of age were recorded. These included fever of more than 100.4 F in 7% of total; irritability in 36.3%; drowsiness in 34.9%; loss of appetite in 16.5%; vomiting in 5.8%; and crying for 1 hour or more in 3.9% [17, p. 3063].

3. The whole-cell DTP vaccine has been associated with acute encephalopathy [17]. A large case-control study that included children 2 to 35 months of age who suffered from serious neurological problem was conducted in England. Acute neurological disorders, such as encephalopathy or complicated convulsion(s) occurred in children who were more likely to have received DTP vaccine the 7 days preceding onset than their age-matched controls. Among children presumed to be neurologically normal before entering the study, the relative risk (estimated by odds ratio) of a neurological illness occurring within 7-day period following receipt of DTP dose, compared to children not receiving DTP vaccine in the 7-day period before onset of their illness, was 3.3 (p< 0.001).

4. Three hundred sixty-five infants were inoculated with Hib, and some of them developed systemic adverse reactions. The following adverse reactions and their percentages occurred in two-month-old infants during the 48 hours following inoculation: Fever > 100.8 F (0.6%); irritability (12.6%); drowsiness (4.9%); diarrhea (5.2%); and vomiting (2.7%) [17, p. 2318].

The above selected studies clearly show that serious health problems and even death can result from vaccinating infants and children, especially among the premature infants. The authors of these studies emphasized that premature infants should be monitored following the administration of vaccines. The Physicians’ Desk Reference stated that physicians should inform the parents or guardians about the potential for adverse reaction of pertussis-containing vaccines (17, p. 3062). The parent or guardian should be given the Vaccine Information Materials, which are required by the National Childhood Vaccine Injury Act of 1986 to be given prior to immunization.

It is unfortunate that baby Alan was given six vaccines (Table 5) and sent home without any consideration of being born five weeks premature and suffering from multiple health problems. His mother stated that the baby developed a high-pitched cry, his skin became warm to touch, and there was an increasing lethargy with a falling-off feeding pattern at about l0 or 11 days following the vaccines (3-4 days prior to his cardiac arrest on November 24, 1997). She was told that these symptoms might result following these vaccinations. On November 24th, the father was alone at home with the baby and his 4-year old sister. The father observed that, in rapid succession the baby began wheezing, next spit up, and then stopped breathing. While attempting to restore breathing, and going (daughter in tow) to a neighbor's house to borrow a car, the father rushed the baby to Princeton Hospital in Orlando, Florida where the baby was eventually resuscitated.

The baby stayed five days in Florida Hospital. Review of the hospital charts from Princeton and Florida hospitals revealed that, at the time of admission on November 24, 1997, baby Alan suffered from diabetes and complications of diabetes, such as metabolic acidosis, gastric ulcer, hypokalemia, apnea, cardiac arrest, hypotension, respiratory acidosis, and infections. Unfortunately, his doctor overlooked the fact that his symptoms resulted from diabetes, and the baby was treated with excessive amount of sodium bicarbonate and heparin, which caused severe hypoxia, cerebral edema, and hemorrhage in brain, lungs, and spinal cord. Detailed description of the hospital events and my analysis of these events are presented in the next section (III). The medical evidence indicates that Alan’s diabetes had resulted from infections induced by the vaccines received on November 11, 1997.

Section III. Review of Alan Ream Yurko’s Medical Records During His Hospitalization on November 24 Through 29, 1997, and Analysis of His Health Problems
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III-A. Clinical events and treatments at Princeton Hospital
Review of the medical records from Princeton Hospital revealed that Alan Ream Yurko was brought into the emergency department of Princeton Hospital by his father, Alan Yurko at about 11:30 AM on November 24, 1997. Mr. Yurko drove a borrowed automobile from his house to the hospital [23]. The child arrived at the hospital either in total cardiac arrest or nearly so. The child was blue and not breathing. The emergency department physicians resuscitated baby Alan, and they started an interosseous line in the left tibia.

The first electrocardiogram was recorded at 11:36 AM and showed only a very slow and ineffective heart rate. At 11:49 AM, the heart rate became adequate. The child was intubated at this time. The first blood gas was done at 12:09 PM, showing a pH of 7.179, a PCO2 of 74 mm Hg, and a PO2 of 585 mm Hg. Other laboratory work drawn at 12:09 PM showed a glucose level of 337 mg/dL, a creatinine level of 0.5 mg/dL, LDH level of 2411 IU/L, SGOT level of 207 IU/L, SGPT level of 121 IU/L, a CO2 level of 13 mEq/L, and anion gap level of 22 mEq/L. The white blood cell count was 20,900 per µL (band 5%, segs 26%, monocytes 8%, lymphocytes 61%), hematocrit value of 23%, hemoglobin concentration of 7.8 g/dL, and the platelet count was 571,000 per µL. Other laboratory work drawn at that time showed a BUN level of 6 mg/dL, total protein level of 5.6 g/dL, albumin level of 3.3 g/dL, sodium level of 139 mEq/L, potassium level of 4.9 mEq/L, and chloride of 104 mEq/L.

Furthermore, his admitting temperature was 93 F. The treating physician, Dr. Ben Guedes, examined the baby, who was flaccid, with fixed and dilated pupils. He showed no signs of spontaneous movement, except for slow, agonal respirations. The corneas were somewhat cloudy. The tympanic membranes were clear and there was no hemotympanum. There was a small reddish linear bruise under the right eye, but no other injuries to the head. The mouth was free of injury externally. The trachea was midline. Examination of the thorax, both anterior and posterior, did not reveal any bruise or other injury. The breath sounds were equal, and chest movement was adequate in the intubated patient. The abdomen was soft, somewhat distended and there were no bowel sounds. Examination of the extremities showed them to be flaccid but grossly normal to inspection. There were no bruises or injuries to the extremities. He developed bleeding from the gastrostomy tube, and Dr. Guedes stated that this was probably from a stress ulcer. His admission weight was 10.05 pounds (4.57 kg).

In the unit, Dr. Ben Guedes started a central line in the right femoral vein and gave the child 15 mEq of sodium bicarbonate in an effort to alter his acid-base status. He also gave him three types of antibiotics—rocephin, gentamicin, and Claforan (cefotaxime sodium)—at high therapeutic doses to fight infections. In addition, he treated the baby with fluid for dehydration, and with other medications to stimulate his heart and respiration. The list of medications given to the baby and doses is presented in Table 6. The baby’s temperature was 98 F at 1:10 PM, and it reached 103 F at 1:45 PM. His blood pressure was unobtainable at 1:10 PM, and rose to 129/88 at 1:45 PM because of the treatment received. At this time his blood pH was 7.3 and his blood PCO2 and PO2 were 31 and 114 mm Hg, respectively.

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References

[1] Medical records of Francine Ream (1997). Florida Hospital, Orlando Florida.
[2] Medical records of Francine Ream (1997). Birthing Cottage of Winter Park,
Inc., 434 Grove Avenue, Winter Park, Florida.
[3] Medical records of Francine Ream (1997). Fairview Hospital, Cleveland Ohio.
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