Why vaccination is more important in preterm neonates?

Preventing infectious illnesses in newborns and children, including preterm neonates, requires vaccinations. 10% of Indian births are preterm less than 37 weeks gestation (WHO,2023). Premature babies may have compromised immune systems. Premature newborns are more prone to illnesses and their sequelae, making vaccination necessary. Vaccine preventable diseases (VPDs) like diphtheria, influenza, invasive pneumococcal disease, bacterial meningitis, pertussis, bacterial and viral pneumonia, rotavirus gastroenteritis, are more likely to hospitalize and kill premature babies. Importantly, the literature suggests that an increased risk of infection positively correlates with the degree of prematurity.

Beyond Vaccination what else increases immunity in preterm neonates

In All preterm infants maximizing use of mother’s own milk (MoM) which helps in preventing infection by transferring passive immunity from mother to baby. Early milk (colostrum), early mother’s milk feed by mouth(Enteral) to the baby and only mother milk without any infant formula (Entirely MoM) helps in preventing infection and increase in immunity of preterm babies . Safe practice like hand washing also should be followed during preterm baby care.

Is the vaccination schedule different for preterm babies

The vaccination schedule for preterm babies is generally the same as for full-term babies. However, there are some considerations and guidelines to follow when vaccinating preterm infants

Adjusted Immunization schedule: Preterm infants might receive their vaccinations on a different schedule than full-term babies. BCG, Hepatitis B though recommended at birth, it is usual practice to administer these vaccines at a later time.

Vaccination Delay: Some vaccines may be delayed for preterm infants, especially if they have specific medical conditions or have received certain medical treatments. The healthcare provider will determine the best time to administer each vaccine based on the baby’s health status. Despite being widely recommended, the routine immunization of preterm infants is frequently delayed, putting this vulnerable population at risk for several diseases, many of which are preventable by immunization.

If vaccination missed in initial few days: If the preterm baby missed any vaccines while in the neonatal intensive care unit (NICU) or for other ilness, a catch-up schedule might be recommended to ensure they receive all necessary vaccinations.

Vaccines in the Neonatal Intensive Care Unit (NICU): Preterm babies who require an extended stay in the NICU may still receive some vaccines during their hospitalization, however live vaccines such as oral polio and rotavirus are not administered in babies who receive preterm care in NICU.

What are Priority Vaccinations which to be completed as per schedule : Certain vaccines, such as those for hepatitis B and pneumococcal disease, are often prioritized for preterm infants because these diseases can cause severe complications in this vulnerable population. Preterm babies who born < 32 weeks may require 4 hepatitis B vaccine in first 6 months as per recommendations. Small preterm babies might be benefited from 1 extra dose of pneumococcal vaccine at 4-5 years age. Special Measures like Palivizumab against respiratory syncytial virus (RSV) in preterm babies who born before 28 weeks’ gestation required in this vulnerable population. In 2023, many international trials approved a new medicine, intramuscular single dose of Nirsevimab, a new monoclonal antibody for prevention of RSV infection in children less than 24 months.

What are precautions to be taken during vaccinations: Any side effects associated with vaccinations are similar in both full term and preterm babies. Few complications such as apnea( brief difficulty in taking breathing) are common in preterm infants immediate post vaccinations, so it’s advisable to vaccinate them under medical supervision. Some preterm infants may experience minor feeding intolerance during primary vaccinations.

What special vaccination strategies beyond neonatal immunization we can adopt to protect this vulnerable population.

Cocoon strategy of Vaccinations: Due to their increased vulnerability, it is also crucial to ensure that every family members including children and caregivers are up-to-date with their vaccinations to create a protective “cocoon” around the preterm baby. This practice helps reduce the risk of the baby being exposed to vaccine-preventable diseases from close contacts. Pertussis, pneumococcal, influenza and COVID 19 vaccinations when received by family members can protect preterm babies. This is one of the emerging practice which can substantially prevent infection in unvaccinated preterm babies.

Maternal vaccinations: India eliminated maternal and neonatal tetanus through immunisation. Maternal immunisation can prevent pertussis, influenza and its potential complication such as such as apnea, pneumonia and seizures in newborns. To acquire the latest information on preterm infant vaccines, see your pediatrician. Medical research and guidelines are always changing. Preterm babies’ parents should discuss their health with their doctors and follow vaccine recommendations.