Keeping Your Preemie Health With Vaccines

Vaccine Schedules for Preemies

A preemie in the NICU receives a vaccination.
A preemie in the NICU receives a vaccination. seanoriordan/Getty Images

When Should Preemies Get Their Vaccines?

Parents of preemies are often surprised to learn that premature babies should get most of their regular vaccines on time, according to the CDC's recommended vaccine schedule. Although most milestones are delayed for preemies, the vaccine schedule is an important exception.

Preemies are born with immature immune systems, so some people think they should wait until they're older before getting their shots.

A few vaccines are delayed for preemies, but most are not. They are given according to the vaccine schedule, and based on preemies' actual birthdays instead of their corrected ages.

Why Should Preemies Get Vaccines on Time?

Vaccines are one of our most important medical achievements. The illnesses they prevent can be devastating, especially to medically fragile children like premature babies. Reasons preemies should be vaccinated on time include:

  • Preventable illness is more common and severe in preemies: Preemies are at greater risk for severe illness from the diseases that vaccines prevent. Pertussis (whooping cough), pneumococcal disease, and flu are both more common and more dangerous in premature infants than in other populations, and are all preventable with vaccines.
  • Vaccines work, even in very small preemies: Although preemies do have immature immune systems, studies show that most vaccines work very well in preemies. Some babies who were born very early or who needed steroids in the NICU may need an extra dose of some vaccines to provide lasting protection.
  • Vaccines are safe for preemies: When healthy preemies at home with their families get their shots on time, they don't have any greater risk for side effects than babies born at term. Babies who are still in the NICU for their first immunizations at 2 months have an increased risk of apnea and desaturations for 2 days after their shots, especially if they have BPD or are still on respiratory support. For this reason, babies should be observed in the NICU for at least 48 hours after their vaccines.

    What Vaccines Should Be Delayed for Preemies?

    Although preemies should get most of their shots on time, there are a few vaccines that should be delayed, including:

    • Hepatitis B: The hepatitis B vaccine is a 3-shot series, and the first dose is usually given shortly after birth. The vaccine doesn't work as well in preemies who weigh less than about 2000 grams (4 lb 6 oz) at birth, so doctors may wait until a preemie weighs at least that much before giving the first shot.
    • Bacille Calmette Guerin: This vaccine is used in some countries to prevent tuberculosis, and is usually given at birth. Because it doesn't work well in preemies born at less than 34 weeks, it won't be given until babies reach this gestational age.
    • Rotavirus: The rotavirus vaccine has a strict dosing schedule. The first dose must be given to healthy infants from 6 to 14 weeks of age. Healthy preemies born at 32 weeks or greater should have the vaccine on time, but babies who were very early may not be able to get the vaccine within the right age range. If it can't be given on time, this vaccine is usually skipped, not delayed.

      Sources:

      American Academy of Pediatrics, Committee on Infectious Diseases. (March 2009). "Prevention of Rotavirus Disease: Updated Guidelines for Use of Rotavirus Vaccine."

      Bonhoeffer, J., Siegrist, C-A, Heath, P.T. (2006). "Immunisation of Premature Infants." Archives of Disease in Childhood. 91: 929-935.

      D.Angio, C. (2007). "Active Immunization of Premature and Low Birth-Weight Infants." Pediatric Drugs. 9(1): 17-32.

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