Abstract
Introduction The Advisory Committee on Immunization Practices and the American Academy of Pediatrics
(AAP) recommend the same immunization schedule for preterm and term infants. However,
significant delays in vaccination of premature infants have been reported.
Objective The objective of this study was to assess the variability of immunization practices
in preterm infants.
Study Design We conducted an online survey of 2,443 neonatologists in the United States, who are
members of the Section for Neonatal-Perinatal Medicine of the AAP. Questions were
targeted at immunization practices in the neonatal intensive care unit (NICU).
Results Of the 420 responses (17%) received, 55% of providers administer the first vaccine
at >2-month chronological age. Most providers (83%) surveyed reported delaying vaccines
in the setting of clinical illness. Sixty percent reported increasing frequency of
apnea–bradycardia events following immunization. More than half administer the initial
vaccines over several days despite lack of supporting data. Reported considerations
in delaying or spreading out 2-month vaccines were clinical instability, provider
preference, lower gestational age, and lower birth weight.
Conclusion This survey substantiates the variability of immunizations practices in the NICU
and identifies reasons for this variability. Future studies should inform better practice
guidance for immunization of preterm NICU patients based on vaccine safety and effectiveness.
Keywords
immunization - preterm - apnea–bradycardia - neonatal intensive care unit
