In accordance with AAP guidelines, VUMC endorses universal immunization against hepatitis B. Recombivax HB, a thimersol-free product, is the vaccine used in the nursery.

Informed consent is not needed when HBV and HBIG are indicated to prevent perinatal vertical transmission of hepatitis B (i.e. if mother is HbsAg-positive or unknown.) Written informed consent should be obtained prior to routine immunization of an infant in the NICU.

Infants born to mothers who are known to be HbsAg-positive, regardless or gestational age or birthweight, should receive the initial dose of hepatitis B vaccine (0.5mL IM) and HBIG (0.5 mL IM) within 12 hours of birth. These doses should be administered concurrently but at different sites.

Full-term infants and preterm infants who weigh > 2 kg at birth should then receive subsequent doses of hepatitis B vaccine at 1-2 months of age and at 6 months of age.

Preterm infants who weigh < 2kg at birth should not have this initial dose counted as one of their required 3 doses. The first dose of the required 3 dose schedule should then be given at 2 months of age with the other routine childhood immunizations. Thus, LBW preterm infants born to HbsAg-positive mothers will receive a total of 4 doses of hepatitis B vaccine.

Infants born to mothers whose HBsAg status is unknown

Term. The infant should receive the first dose of hepatitis B vaccine (0.5 mL IM) within 12 hours of birth. The mother should undergo HBsAg testing as soon as possible. If she is HBsAg-positive, the infant should receive HBIG (0.5 mL IM) as soon as possible and within 7 days of birth. Regardless of mother’s status, subsequent HBV doses will be due at 1-2 months and 6 months of age.

Premature:  The infant should receive the first dose of hepatitis B vaccine (0.5mL IM) within 12 hours of birth.  The mother should under go HBsAg testing as soon as possible; however, if results of maternal testing will not be available within 12 hours of birth, the infant should receive HBIG (0.5mL IM).   HBIG should be given in this population because of the poor immunogenicity of the hepatitis B vaccine in the < 2 kg preterm infant.  For the same reason, this first dose of hepatitis B should not be counted as one of the required 3 doses for immunity.   The first dose of the required 3 doses schedule should then be given at 2 months of age with the other routine childhood immunizations.

Infants born to mothers who are HBsAg-negative

Term and near-term infants > 2 kg should receive their first dose of hepatitis B vaccine (0.5 mL IM) prior to hospital discharge. Subsequent doses should then be given at 2 months and 6 months of age. Alternatively, these infants may receive their hepatitis B immunizations at 2, 4, and 6 months along with the other routine childhood immunizations.

Preterm infants with birthweights < 2 kg should have their first hepatitis B vaccine delayed until 2 months chronologic age when it can be given in conjunction with other routine childhood immunizations.

Reference:

American Academy of Pediatrics. Red Book 2000, 25^th edition. pgs. 298-300.