Given the high prevalence of intramuscular injections during infancy, NiS seems to be a rare event, but there is a possibility of under-reporting of less severe reactions. Our retrospective data do not allow a true risk assessment. The most worrying aspect of NiS, however, is its lack of predictability. As long as complete avoidance of the intramuscular route is not an option, it is obvious that NiS cannot be completely prevented.
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