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Updated: Feb 9, 2026

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Variability in Immunization Practices for Preterm Infants.

Srirupa Hari Gopal1, Kathryn M Edwards2, Buddy Creech2

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Vaccination schedules for preterm infants vary widely in neonatal intensive care units (NICUs), with many providers delaying or spreading out immunizations despite recommendations. This highlights a need for improved practice guidance for preterm infant vaccination.

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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.