Administer vaccines based on chronological age, irrespective of birth weight or gestation period.
Provide full standard dose of vaccines without reduction.
Ensure deep intramuscular administration in anterolateral thigh using a 5/8 inch or smaller needle.
Preterm infants mount adequate immune responses comparable to term newborns.
Prematurity itself is not a contraindication to immunization.
Specific Vaccine Recommendations
Hepatitis B Vaccine Management For Infants Weighing <2000 Grams
Decreased immune response observed when vaccine administered before one month of chronological age.
Birth dose must not be counted as part of the primary series.
Maternal HBsAg Status
Action Plan
Positive
Give Hepatitis B immune globulin + Hepatitis B vaccine within 12 hours of birth. Do not count birth dose. Give three additional doses at 6, 10, and 14 weeks.
Unknown
Give Hepatitis B immune globulin + Hepatitis B vaccine within 12 hours. Test mother for HBsAg. Do not count birth dose. Give three additional doses at 6, 10, and 14 weeks.
Negative
Give birth dose but do not count as part of primary series. Follow with standard primary doses. Alternatively, first dose may be postponed by one month.
Bacillus Calmette-Guerin Vaccine
Recommend early administration in stable preterm and low birth weight infants.
Best administered after stabilization and preferably at time of hospital discharge.
Rotavirus Vaccine
Consider vaccination if infant is clinically stable and at least 6 weeks of age.
Defer administration until hospital discharge to prevent potential health care-associated viral spread.
Pneumococcal And Influenza Vaccines
Prioritize administration due to increased infection susceptibility.
Very low birth weight infants face up to ninefold higher incidence of invasive pneumococcal disease.
Administer age-appropriate pneumococcal conjugate vaccine.
Respiratory Syncytial Virus Immunization
High-risk preterm infants require protection against lower respiratory tract disease.
Administer long-acting monoclonal antibodies like Nirsevimab or Clesrovimab during or entering first respiratory syncytial virus season.
Post-Exposure Prophylaxis For Varicella
Significant exposure warrants varicella zoster immunoglobulin or intravenous immunoglobulin administration.
Preterm infants >28 weeks gestation require prophylaxis if no maternal immunity exists.
Preterm infants <28 weeks gestation or birth weight <1000g require prophylaxis irrespective of maternal immunity status.
