THE NINE THINGS ABOUT VACCINATION YOU SHOULD KNOW IF YOUR BABY IS PREMATURE

In Spain, nine out of 100 newborns are premature, one of the highest rates in the surrounding countries. The good news is that scientific advances and medical care are making possible a survival rate of up to 65% in those born before week 28, and 95% in those born after.

But given their vulnerability, premature babies constitute an important risk group against diseases and infections, so it is essential to carry out a correct vaccination according to their circumstances. We explain everything you should know about vaccines if your baby is premature.

Especially vulnerable to infections

It is considered that a baby is born prematurely when it does before 37 weeks gestation, something that occurs in 7-10 percent of births in countries around us.

Within the group of premature babies there is one especially vulnerable, and it is constituted by babies born before 32 weeks and weighing less than 1,500 kilos, and especially those under 28 weeks and a kilo of weight (the so-called premature babies extremes)

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Due to the immaturity of the cutaneous and mucosal barriers and their immune system premature babies are especially vulnerable to infections, especially those caused by bacteria such as H.influenzae type B and pneumococcus. That is why vaccination in this group is more important and essential even if it fits.

Basic considerations on the vaccination of prematurity

Two months is the age at which newborns usually receive their first vaccinations, but in the case of premature babies, many doubts arise in this regard: Should they be vaccinated according to their chronological or corrected age? Do they receive the same antigenic load as a full-term newborn?

As we can read in this manual of the Spanish Association of Pediatrics, these are the most important general considerations that we must take into account when starting vaccination in the premature newborn:

1) Attend to your chronological age, not corrected

The premature one should be vaccinated according to his chronological age, regardless of gestational age and birth weight.

Therefore, it is extremely important to start vaccination at two months of age and except for exceptional situations determined by the medical team, the vaccination age should not be delayed.

2) If you are hospitalized, you can receive your vaccinations

In case the premature baby is admitted when the vaccination has to begin, he will receive the corresponding doses in the hospital, as long as it is clinically stable.

3) Similar immune response for most vaccines

The Immune response to vaccines in premature infants is similar to that obtained in the term newborn for vaccines of DTPe, DTPa, Polio 1 and 2, Pneumococcus and Meningococcus, but lower for Hepatitis B, Hib and Polio 3.

But nevertheless, upon completion of the primary vaccination Almost all children reach protective concentrations of antibodies against the various vaccine antigens, achieving sufficient immunity to prevent disease.

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4) The dose should not be reduced

The antigenic load of each dose is similar to that used in a full-term newborn, since there is no basis for using reduced or fractional doses and, conversely, this practice may end in an inadequate immune response.

5) All vaccines are safe for premature

As we can read on the website of the Spanish Association of Vaccination:

"All recommended calendar vaccines are safe in premature children and the possible adverse effects attributable to vaccines are mild and similar to those that appear in mature newborns."

6) Symptoms after vaccination

The premature newborn usually reacts the same after the administration of vaccines than those born at term, if any, a lower tendency to the appearance of fever, irritability, drowsiness or loss of appetite.

7) Considerations when pricking the vaccine

Since the premature newborn has little muscle mass, vaccines should be given using shorter needles, and in the case of intramuscular vaccines will be administered on the anterolateral thigh.

8) The use of combination vaccines is advised

One of the things that worries parents the most when it comes to vaccinating their babies is the number of punctures you should receive, all the more so if the newborn is premature and, as we have said, has less muscle mass.

Thus, in these cases the use of combined vaccines (several vaccines in a single injection) is considered more appropriate, as they are equally safe, the immune response is the same and the number of punctures is reduced.

9) All vaccines on the calendar

Unless the doctor indicates otherwise, the premature baby should receive all vaccines on the calendar when appropriate, including meningococcal B vaccine, rotavirus and seasonal flu.

The Vaccine Advisory Committee of the AEP has prepared a report on the recommendations of the hexavalent vaccine according to each Autonomous Community. In your health center they will inform you of the guidelines to follow according to the birth weight and gestational age of your baby.

But in addition, there are some additional considerations about certain vaccines to consider, and which we will discuss next.

Vaccines the premature should receive

As we have just commented, unless the medical team or the pediatrician indicates otherwise, the official schedule of vaccines with their corresponding doses and the age of aminsitración of the same, is the same in those born at term as in premature babies.

But there are some specifications that we will detail:

Vaccination against Hepatitis B should be administered taking into account the mother's serological status.

In this way, if the mother has positive or unknown serology, the premature newborn (regardless of birth weight) should receive the vaccine along with specific anti-hepatitis B immunoglobulin within 12 hours of birth. Then you will continue with the three doses marked in the official calendar.

The current pneumococcal vaccination schedule consists of three doses administered at two, four and 11 months of age. But given its greater vulnerability to invasive infection by this pathogen, premature children under 32 weeks or 1700 grams in weight must follow a 3 + 1 guideline.

The Vaccine Advisory Committee of the AEP has prepared a report on this vaccination schedule according to each Autonomous Community, so if your baby is premature, find out in your health center how to proceed in this regard.

Rotavirus gastroenteritis can be a particularly serious disease in premature RNs, which is why ACIP and WHO consider that The benefits of this vaccine outweigh the hypothetical risks. Thus, the AEP recommends administering this vaccine to premature infants, at the same age as it is administered to term infants.
Premature babies have a higher risk of complications, hospitalizations and mortality due to infections due to the flu virus, so it is recommended that they receive the flu vaccination from six months of age and as soon as possible the start of the season.
Regarding the meningococcal B vaccine, we can read this in the AEP:

"The vaccine against meningococcus B (Bexsero) can be given to premature newborns with the same pattern as term, although the possible risk of apnea and the need for respiratory control for 48-72 hours after primary vaccination in very premature children (born below 28 weeks gestation) and, in particular, those with a previous history of respiratory immaturity As the benefit of vaccination is high in this group of children, it should not be canceled or delayed. "

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The importance of indirect protection

But if there is something fundamental for the premature newborn is the immunization of people living with himHence, both adults and children should have their vaccination schedules up to date, as well as the annual flu vaccine.

The vaccination of pregnant women is also particularly important against whooping cough and the flu, as it could prevent very serious complications in infants. The main problem is that in the current recommendations vaccination is between weeks 27 and 32, so that a part of premature babies does not benefit from this measure. That is why, in countries like the United Kingdom, earlier vaccination strategies have been established (between 20 and 32 weeks).