[couchdogs]

At the hospital I am currently working at we are to ask the parents if they want the optional newborn hep B vacc. and try to get it administered (if they want it) within 12 hours of life. Many parents do not have a preferrence one way or the other about it and seem to rely on the nurse to tell them what to do. I want to provide my patients with a clear picture of the pros and cons of getting the vacc that early and in which situations would you definately want to or not want to give the shot. And why the 12 hour deadline. I know we have given it after the 12 hours before when the mom wanted to discuss it with doctor the next day but for the most part we are told to rush it. Any help out there with this topic would be greatly appreciated.

[dancingdoula]

What's the rationale your hospital gives? I've heard we have a new policy in our NICU that all babies get it, especially if mom's Hep status is unknown, but since I work nights I never have had to. I also hear they're trying to make it policy that we don't have to have consent from the parents for ANY vax which makes me pretty uncomfortable.

[HeartsOpenWide]

Originally Posted by dancingdoula

What's the rationale your hospital gives? I've heard we have a new policy in our NICU that all babies get it, especially if mom's Hep status is unknown, but since I work nights I never have had to. I also hear they're trying to make it policy that we don't have to have consent from the parents for ANY vax which makes me pretty uncomfortable.

What state are you in? If some one gave my child a vax without my consent lawyers would be involved. We can't even give pacifiers or formula without parent consent. At the hospitals where I live no vaccinations of any kind are given unless needed (i.e. mother positive for hep B) many parents sign a wavier not to get eye ointment and some even wave the Vit K but it is strongly encouraged.

I can see if the hospital suspects that the parents would never get around to getting their children vaccinated then they might want to go ahead and do it at the hospital; but I don't see any reason in that since hep B is a 3 part series. I do not think it is needed at the hospital in anyway besides a pos mother...last time I checked newborns and toddlers were not having sex.

[mom2michael]

I work in a very parent friendly unit that doesn't impose much on parents. Sometimes a little too lax but.....

If a baby needs that Hep B within a certain # of hours for whatever reason, I truly feel this needs to be addressed by the OB and the peds doctor and really should've already been done long before they reach my floor. I myself will not give "advice" on immunizations or medications to parents, instead I will encourage them to read the info provided to them on check in and call their peds doc for more questions if necessary.

For those with no PNC, our peds doc rounds quickly on them cause of the GBS and various other issues that can pop up rather quickly in these little buggers.

I'm really good at shifting this back onto the parents. They've had 9 months to make these decisions and to talk to their peds doctor about their decisions and choices. Of course, if they've had no PCN, then I encourage them to talk to the peds doc when he rounds.

We have a consent for everything under the sun and I really believe that when a parent signs an INFORMED consent that they are INFORMED of what they are signing. If that means waiting for the peds doc to round or for the 3-5 day check up, then I'm good with that too.

For me I can see the lawsuit now.....Jimmy's nurse told me I had to have the Hep shot within 12 hours, so I did it but I didn't understand the risks, now Jimmy is Autistic and it's all her fault because she made me do it.

I would question the 12 hour "rule". Chances are its more of a paper trail and continuity thing that an actual guideline set forth by anyone other than a paper pusher.

[couchdogs]

There is no written policy on the 12 hour rule, just something that all the staff was told and have been practicing. Sometimes units get stuck in a rut doing something one way and not questioning it because they are not aware of what other hospitals are doing. In order to give the vaccination we just get a verbal consent and then they must sign a decline form if they refuse it. I usually approach the patient with the decline form and then explain they have the option to have their baby vaccinated if they want but I in no way push for it. They start the series at the peds office around 2 months anyways.

[clhRN2b2010]

This likely won't help you much, but my ped finally confessed (after much pressure) that the reason is two fold.

The vaccine manufacturer wanted it that way, (for obvious $ reasons), wrote the FDA protocol to give it within the first 12 hours and sold the FDA on it by using the arguement of compliance. "You will get X% higher compliance if given before leaving the hospital".

Even though my ped admitted that he wouldn't have given it to his own children at birth; he does appreciate the compliance. He seriously gets a "report card" from the state based upon his vax rates that in turn is utilized by insurance companies to determine participation.

yeesh.

[CEG]

As far as I can tell there is no benefit. The only thing anyone has ever been able to tell me is that it improves compliance- which is not valid in my mind. It is a three shot series so if someone has the first shot they still have to return for the other two anyway.

What we have done by giving it in hospitals is made it into a four-shot series because Hep B is part of the COMVAX vaccine which is given at something like 2, 8, and 12 months of age. So most doctors are just ignoring the fact that Hep B is in the COMVAX because it is too expensive to stock COMVAX components separately just for that last dose. So the child who gets it in the hospital is getting a fourth dose.

So basically the benefit is $$$$$ for Merck. There is no way I would get the Hep B vaccine in the hospital for my baby.

Wanted to add a link to the package insert:
http://www.merck.com/product/usa/pi_...ombivax_pi.pdf
http://www.merck.com/product/usa/pi_.../comvax_pi.pdf

[nurseshepherd]

Our hospital policy requires parental consent and the parents are provided a one page info sheet explaining the HBV with pros and cons listed. Problem is our folks RARELY ready anything, they just sign what needs signing to complete the admission process. Our orders read that the vaccine will be given before discharge if consent has been obtained. I wish the researchers had a more definite answer so we can either stop giving it or stop worrying about it.

[crysobrn]

I think that the peds really need to talk to the patients more about vaccinations in general. I don't like to get consents for it if there is any question in the parents mind... I give the info sheets from the cdc and then let them keep the consent and let them discuss it with their pedis... We get a consent signed either way, they either check "I want" or "do not want" and then sign.

I've heard nurses say "the docs like the baby's to get the shot before they leave" well if I were the patient I'd say "why"

I skip it in the hospital for my babies. The only advantage I saw before was when our peds office had the comvax the kids got less pokes because they got all their 2 and 6 mos immunizations in one shot... But our office didn't have them for a long time.

I think our protocol is that they have it within 12 hrs with immune glob if the mother is pos... But other than that our orders say "hep b before discharge with parents consent."

[beachmom]

I read somewhere that when they first made the vaccine, they tried giving it just to high risk groups, but that didn't affect the rate of the disease. When they gave it to everyone, then the rate came down. It's too hard to target a vaccine as no one wants to admit to being in a high risk group.

I was told they start it at birth because then the second two shots are due on already scheduled well baby check days. I don't work in a clinic, so I can't vouch for that.

Personally, I wish I didn't have to give it.

I don't know anyone who has ever had hep B (besides patients at work), so it's not a disease I personally worried about before being a nurse. As a nurse, I got the shots because of possible exposure, but if I wasn't a nurse, I wouldn't get them.

My mom remembers every few years polio would come through town and kill or disable a few people. Most people used to get measles, some very seriously. I feel those shots are a lot more justified than hep B.

Why do babies need to be poked on their first day of life to protect them from a disease they probably won't ever be exposed to (as it's bloodborne), and if they are, it probably won't be until they are a teen or adult?