What vaccinations are recommended for a 6-week-old former preterm (premature) infant, born at 31 weeks gestation, with a history of brief oxygen supplementation via Continuous Positive Airway Pressure (CPAP) and nasal cannula, and phototherapy for hyperbilirubinemia (jaundice)?

From the Guidelines

This 6-week-old former premature infant should receive routine vaccinations according to his chronological age, not his corrected gestational age. At this visit, he should receive his 2-month vaccines, which include DTaP (diphtheria, tetanus, acellular pertussis), IPV (inactivated polio vaccine), Hib (Haemophilus influenzae type b), PCV13 (pneumococcal conjugate), rotavirus vaccine, and hepatitis B (if not already given at birth) 1. The doses are standard regardless of his prematurity or low birth weight. Additionally, palivizumab (Synagis) should be considered for respiratory syncytial virus (RSV) prophylaxis during RSV season since he was born at less than 32 weeks gestation. Palivizumab is administered as a monthly intramuscular injection of 15 mg/kg throughout the RSV season. Premature infants have the same immunologic responses to vaccines as term infants and should not delay vaccination, as they are at higher risk for vaccine-preventable diseases 1. The parents should be informed about potential side effects including fever, irritability, and injection site reactions, which can be managed with acetaminophen if needed. The infant should return for his next set of vaccinations at 4 months of chronological age. It's also important to note that preterm infants can be immunized with rotavirus vaccine on the same schedule and with the same precautions as term infants, as long as they are clinically stable and meet the age requirements for the vaccine 1.

From the Research

Vaccine Schedule for Preterm Infants

The parents of a 6-week-old boy, born at 31 weeks gestation, are inquiring about upcoming vaccines for their infant. According to the studies, here are the key points to consider:

• Preterm infants should be vaccinated using the same schedules as those usually recommended for full-term infants, with the exception of the hepatitis B vaccine 2, 3, 4.
• The US Advisory Committee on Immunization Practices recommends that infants beginning at birth receive several vaccines directed against a variety of infectious diseases, including the 3-dose hepatitis B (HepB) series 5.
• For preterm infants, additional doses of the hepatitis B vaccine should be administered if they weighed less than 2000 g at birth, due to a documented reduced immune response 2.
• Available data evaluating the immune response of preterm infants support early immunization without correction for gestational age, and vaccines are immunogenic, safe, and well tolerated in preterm infants 2, 3.

Recommended Vaccines and Schedule

Based on the studies, the recommended vaccines and schedule for the 6-week-old boy are:

• Hepatitis B vaccine: The first dose is due at birth, and the second dose is due at 2 months. Since the boy is now 6 weeks old, he is likely due for his second dose soon.
• Other vaccines: At 2 months, infants are to receive a series of vaccines directed against diphtheria, tetanus, pertussis, pneumococcus, rotavirus, poliovirus, and Haemophilus influenzae type b 5.
• Influenza vaccine: Starting at 6 months, depending on the time of year, infants are to begin a 2-dose series against influenza separated by 28 days 5.

Key Considerations

• Preterm infants are at an increased risk of morbidity and mortality from vaccine-preventable diseases, and delays in routine immunization are common 3.
• Available guidelines clearly state that preterm infants should be immunized according to chronological age, irrespective of gestational age and birth weight or current weight 3, 4.
• Neonatal nurses need to stay current on the recommendations for immunizations commonly used in the NICU setting and provide reliable and verifiable information to parents 4.