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The immune system of preterm infants: an overview

Mirjam J Esser1,2, Sanne J C M Claassen2,3, Melania P Ebrahimi1

  • 1Department of Pediatrics, Maastricht University Medical Center, MosaKids Children's Hospital, Maastricht, Netherlands.

Frontiers in Immunology
|June 22, 2026
PubMed

Insights

Preterm infants have immature immune systems, increasing infection risks. Their immune function rapidly matures in the first year, improving but still differing from full-term infants.

Area of Science:

  • Immunology
  • Neonatal Medicine
  • Pediatrics

Background:

  • Approximately 13 million infants are born preterm (<37 weeks gestation) annually.
  • Preterm infants face higher infection-related morbidity and mortality due to immune system immaturity.
  • This immaturity is particularly pronounced in early life, affecting both innate and adaptive immunity.

Purpose of the Study:

  • To provide an updated overview of immune system phenotype and function in preterm infants compared to term infants.
  • To emphasize the adaptive immunity aspects in preterm infants.
  • To offer a framework for understanding the immunological mechanisms behind increased infection risk in preterm infants.

Main Methods:

  • This study is a review of current literature.
  • It compares the immune system of preterm infants with that of term infants.
  • The focus is on phenotypic and functional characteristics, including adaptive immunity.

Main Results:

  • Preterm infants exhibit immature innate and adaptive immune cells at birth.
  • Reduced antibody levels and diminished vaccine immunogenicity are observed.
  • Impaired pathogen clearance and suboptimal vaccine responses contribute to increased susceptibility.

Conclusions:

  • Immune immaturity is a significant factor in the heightened infection risk for preterm infants.
  • Rapid immune maturation occurs during the first year of life.
  • Understanding these immunological mechanisms is crucial for developing strategies to improve preterm infant health outcomes.

Keywords:
B cellsT cellsadaptive immunityantibodiesimmune systeminnate immunitypretermvaccination

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