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Premature infants should receive their routine childhood immunizations based on their chronologic age, not their corrected age (Red Book: Report of the Committee on Infectious Diseases, American Academy of Pediatrics.) Therefore, babies who remain in the NICU for the first 60 days of their life will begin their immunizations while in the nursery.

Written informed consent should be obtained prior to routine immunization of an infant in the NICU. Phone consent is permissible when parents are unable to visit. The lot number, dose and site of immunization should be recorded.

At 2 months, 4 months, and 6 months of age, the following immunizations are due:

DTaP (diphtheria toxoid, tetanus toxoid, and acellular pertussis vaccine) 0.5mL IM

Hib (haemophilus influenza type B conjugate vaccine) 0.5mL IM

IPV (inactivated poliovirus vaccine) 0.5mL subcutaneous

Hepatitis B (Recombivax HB is thimerisol-free) 0.5mL IM

Prevnar (pneumoccocal 7-valent conjugate vaccine) 0.5mL IM

 Currently, Vanderbilt pharmacy has available Pentacel, a 5 in 1 combination vaccine which provides DTaP, IPV, and Hib protection.  For 2 month old infants who are due for all the above immunizations, the use of Pentacel will decrease the number of shots necessary to 3.

Acetaminophen (Tylenol) may be given for immunization-related discomfort.  Acetaminophen should not be given within less than 4 hours before or after any active immunization.  If needed, provide acetaminophen 10-15 mg/kg/dose PO/OG or 20 mg/kg/dose PR q 6-8 hours prn for 24 hours.

Special considerations:

·         Immunizations may need to be delayed if the infant is clinically compromised at a chronologic age of 2 months. Specific timing of shots thereafter will need to be adjusted on an individual basis. Subsequent doses of these vaccines are recommended at 2 month intervals; a minimum of 6 weeks should elapse between doses.

·         Very small infants may benefit from having their immunizations given over 2 days rather than receiving multiple shots all at once.

·         "Misbehavior" (increased As&Bs, increased FiO₂ requirement, etc.) is not infrequent after immunizations especially in the former micropremie and should be anticipated.

References:

American Academy of Pediatrics, Red Book. 28^th ed; 2009. http://aapredbook.aappublications.org/cgi/content/full/2009/1/1.7.1#RFN18.

CDC. FDA Approval for Infants of a Haemophilus influenzae Type b Conjugate and Hepatitis B (Recominant) Combined Vaccine.  MMWR 1997; 46, 107-109.

http://www.cdc.gov/mmwr/preview/mmwrhtml/00046158.htm

Pourcyrous et al. Interleukin-6, C-reactive protein, and abnormal cardiorespiratory responses to immunization in premature infants. Pediatrics 101(3):E3, 1998.

Slack et al. Severe apnoeas following immunization in premature infants. Arch Dis Child 81(1):F67-8, 1999.

Chen et al. The yin and yang of paracetamol and paediatric immunisations. The Lancet. 2009;374:1305-6.

Carbone et al. Absence of an increase in cardiorespiratory events after diphtheria-tetanus-acellular pertussis immunization in preterm infants: a randomized, multicenter study. Pediatrics. 2008;121:e1085-90.