Trends in Neonatal Vaccination: A Ten-year Retrospective Study in a Large Delivery Center

Newborns are at increased risk of vaccine preventable morbidity and mortality. The American Academy of Pediatrics recommends administering the birth dose of the hepatitis B vaccine (HBV) between 0 and 30 days of life [based on birth weight (BW) < 2000 g vs. ≥ 2000 g], followed by several vaccines at 2 months of age (regardless of the BW) including the first dose of the pneumococcal vaccine (PCV). However, adherence to these guidelines is often suboptimal, resulting in incomplete or delayed vaccination.

This is a 10-year retrospective, single-center observational study examining the rates and timeliness of HBV and PCV vaccination of infants admitted to the mother-baby unit and neonatal intensive care unit (NICU) from 2013 to 2023. Multinomial logistic regression was used to examine factors associated with vaccination status.

HBV vaccination of infants admitted to the neonatal intensive care unit (n = 4935) was significantly more likely to diverge from American Academy of Pediatrics recommendations versus HBV vaccination of infants admitted to the mother-baby unit (n = 49,857). Factors associated with higher relative risk of delayed HBV vaccination included administration in the pre-COVID prepandemic era, prematurity, BW ≥ 2000 g and Black/African American race, with the latter two also being associated with incomplete vaccination at discharge. For PCV, Hispanic patients were more likely to be discharged with incomplete vaccination compared with non-Hispanic patients.

Postpandemic, there were lower rates of delayed vaccinations, possibly reflecting increased vaccine awareness among parents and providers. Preterm status was a key factor influencing HBV vaccination timeliness. Perceptions and attitudes toward early-life vaccination, including potential racial biases, should be examined as potential contributors to differing vaccine administration practices.