Premature Infants and Vaccines
Mar 05, 2013

DrZibnersFor the past few months, Dr. Lara Zibners has been addressing questions that we receive from on our Vaccinate Your Family Facebook page.  Today’s question addresses premature infants and vaccines.  If you have a vaccine related question that you would like us to address, please email Vaccinate Your Family at or send us a message on our Facebook page.

“Should vaccines be postponed for premature infants? I’ve been trying to do research, but I’m too sleep deprived to make any sense of it. I vaccinated my son who was full term, and I’m all for vaccines. I just didn’t know if there were exceptions for preemies.”

Having a baby prematurely means more than just rearranging your plans this weekend, doesn’t it?  Whether expected or not, seeing your baby born preterm (meaning less than 37 weeks) is a stressful and often frightening experience for parents. One of my daughters was born slightly early and was very underweight. I was terrified. Although she was perfectly healthy, it took her an hour to drink a few teaspoons. You couldn’t hear her pathetic little cry from more than a few feet away. And I was consumed with this inexplicable urge to throw myself over her warming bed to protect her from the other “giant” (as in actually normal-sized) infants in the nursery.

So you can imagine my horror when the nurse brought out the hepatitis B vaccine and the needle looked surprisingly large, especially next to my tiny little girl.  But like you, I’m passionate about vaccination. And the truth is that medically stable preterm and low-birth weight babies should be vaccinated on the same schedule as all other infants. With the same vaccines. At the same dosage. Even if it looks like the syringe weighs more than the child. (Which it doesn’t. I’m exaggerating. Really, I am. Anyway.)

preemieYou might be looking at your tiny little preemie and thinking, “Gosh, he’s so vulnerable. It is really safe to give him the same dose as a full-term baby? Is his tiny little body really up to the challenge?” But the answer is exactly that: he’s vulnerable. As in even more vulnerable to the sometimes devastating effects of vaccine-preventable illness than other infants. And there is plenty of evidence that vaccines are safe and effective in all babies, regardless of how early or late they decide to enter the world.

Unfortunately, many parents and even some doctors are hesitant to vaccinate preemies on the recommended schedule which is based on age from birth, not from expected due date. Which puts the most defenseless of babies in danger.
So there you have it. In short, unless your preemie is medically unwell, there is no reason to delay his vaccines. And to be truthful, many reasons why it’s utterly vital for preemies to be immunized on time. Whether still in the hospital, or already home with you, vaccines should be given on the same schedule, at the same intervals, as they are given to any other baby, with very few exceptions (such as with hepatitis B and rotavirus vaccines, as detailed below). It may feel counter-intuitive– and I certainly didn’t enjoy the stink eye my daughter gave me when I stripped the scrawny little thing down for her 6-week shots– but it’s the right thing to do.

More detailed information regarding vaccines for premature babies can be found on the Vaccine Education Center website, to include the following:

Most premature infants, including those with low birth weights, can be immunized at the usual chronological age. In other words, a child born two months early should still receive his or her first immunizations at 2 months of age (not at 4 months of age).

An exception to this rule is the hepatitis B vaccine. Premature infants (children born within 36 weeks of conception with a birth weight of less than 4.4 pounds) whose mothers are not infected with hepatitis B virus should receive the hepatitis B vaccine at 1 month of age or at hospital discharge, whichever comes first. However, premature infants whose mothers are infected with hepatitis B virus should receive the vaccine at birth, independent of birth weight.
If an infant is at least 6 weeks old and has been hospitalized since birth, the first dose of rotavirus vaccine should be delayed until the infant is discharged from the hospital unless discharge occurs after 15 weeks of age. Due to a lack of safety data, the rotavirus vaccine cannot be started after an infant is more than 15 weeks old.

The Vaccine Education Center also highlights the following literature review on the topic of vaccines and premature infants:

Susanna Esposito and colleagues recently published an article entitled, “Immunogenicity, Safety and Tolerability of Vaccinations in Premature Infants,” which can be accessed on Medscape. The authors concluded that while additional data should be sought regarding newer vaccines, existing data shows that premature infants should follow the same schedule as that of full-term babies.

Read more about vaccinations for premature babies on the Vaccinate Your Family website.

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