Immunizations in Premature Infants

All infants are more vulnerable to infections because of immaturity of their host defense mechanisms.  This is particularly true for premature infants who are highly vulnerable to infectious diseases and in need of subsequent protection.   In the past, premature infants have not been adequately immunized because of fear of adverse reactions and poor antibody response to the immunizations, lack of adequate muscle mass for the injections, or the premature infant simply being "too small" or "too sick" to immunize.

The American Academy of Pediatrics currently recommends that all premature infants receive full-dose immunizations at the same chronologic age as term infants, even if they are still hospitalized.  The above noted concerns have simply not been found to be valid.  For the majority of premature infants, their protective antibody responses to immunizations are comparable to those seen in term infants.   Even for the few premature infants who may not respond "as well" as term infants in developing antibodies, their responses are still adequate and protective.   Premature infants generally tolerate immunizations better and experience fewer febrile and local reactions to immunizations because of their more immature immune systems.  Contraindications to immunizations are the same for all infants and include a significant febrile illness, active seizure disorder or encephalopathy, or any known allergies to the vaccine components (i.e. eggs).

Premature infants over 6 months but less than 2 years of age with a history of bronchopulmonary dysplasia or reactive airway disease should be considered for vaccination against influenza each Fall. The flu vaccine can be given in split doses to ensure toleration.

Many premature infants are now eligible to receive prophylaxis against the respiratory syncytial virus (RSV).  This is a monthly injection given during RSV season which is typically Fall to Spring. Families may check with their family physicians to see if their premature infant warrants RSV prophylaxis and where it can be obtained.  There is also now a vaccine available against Rotavirus, which is the most common virus responsible for severe diarrheal illness in infants and young children. There are currently no guidelines regarding Rotavirus vaccine administration specific for premature infants.  Families are urged to consult their family physicians for further details on the Rotavirus vaccine.

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