Variability in Immunization Practices for Preterm Infants

Area of Science:

• Neonatal Medicine
• Pediatric Immunology
• Public Health

Background:

• Current guidelines from the Advisory Committee on Immunization Practices and the American Academy of Pediatrics (AAP) recommend identical immunization schedules for preterm and term infants.
• Despite these recommendations, significant delays in the vaccination of premature infants have been observed in clinical practice.

Purpose of the Study:

• To assess and quantify the variability in immunization practices for preterm infants within the neonatal intensive care unit (NICU) setting.
• To identify the specific factors contributing to deviations from recommended vaccination schedules in this vulnerable population.

Main Methods:

• An online survey was distributed to 2,443 neonatologists in the United States, members of the AAP's Section for Neonatal-Perinatal Medicine.
• Survey questions focused on current immunization practices, including timing, delays, and administration methods for vaccines in the NICU.
• A total of 420 responses (17% participation rate) were analyzed.

Main Results:

• A substantial majority of surveyed providers (55%) administer the first vaccine dose after 2 months of chronological age.
• Most providers (83%) reported delaying vaccinations when infants experience clinical illness.
• Sixty percent of respondents noted an increased frequency of apnea-bradycardia events post-immunization, and over half spread vaccine administration over several days without supporting evidence.

Conclusions:

• The study confirms significant variability in immunization practices for preterm infants within the NICU.
• Clinical instability, provider preference, lower gestational age, and lower birth weight were identified as key reasons for vaccine delays or altered administration.
• There is a clear need for evidence-based practice guidance to optimize vaccine safety and effectiveness in preterm infants cared for in the NICU.