Vaccinations in the NICURegister Today!
This is a discussion on Vaccinations in the NICU in NICU Nursing / Neonatal, part of Critical Care Nursing ... Hello fellow NICU nurses: Mostly a lurker but used to post on here a lot a few years ago. ...by Humbled_Nurse Jul 28, '12Hello fellow NICU nurses:
Mostly a lurker but used to post on here a lot a few years ago. Anyway I am wondering how your NICU handles vaccinations. As most of you are aware vaccinations have become a hot topic in the last few years. More and more parents are researching them and making more informed decisions instead of just assuming what the pedi. tells them to do is the best way.
In our unit the Neo's are wanting the babies to get their 1st hepatitis B at 30 days of age regardless of weight, condition, etc... If the kid is super sick (HFOV, drips, etc...) they probably would postpone it, but we have had lots of micropreemies still on SIMV or Bubble CPAP who haven't even reached the 1000 g mark and they are still wanting them to get their 1st Hep B shot. What's the rush? It just doesn't sit right with me. When you compare the babies up in the well baby nursery who weigh anywhere from 5 pounds and up and they get the same dose as a 1-1/2 pound baby it just doesn't seem right. We are so concerned about their neurological development in the NICU so we keep the lights low, the noise low, contain them, etc.... but we give them an immunization that I believe can have an effect are their still developing brains. Also we give the 2 month shots at 60 days which seems to be routine in most NICU's. I think most babies probably do fine with it, but I have seen many babies have setbacks after those 2 month shots. Some of these babies are still weeks from going home and just still seem too fragile to handle all these shots, but the Neo's insist it's just fine.
I used to not really give vaccinations a second thought, but lately it is really bothering me and I just don't see the point in giving these babies their shots so soon. Why can't they just wait until they leave the NICU and let the pedi. handle it when they feel the time is right. Like waiting until at least 2 months past their original due dates. I had a lengthy conversation with one of our Neo's about vaccinations and he even admitted that there were some vaccines that he didn't give his kids until they were at least 2. I know that the Neo's just follow the AAP guidelines and just want to keep these babies on the recommended schedule, but I don't think we are doing any of these babies any favors.
I am not necessarily anti vax, but I think we need to wait a little longer with some of the preemies in the NICU and not administer them in a 1 size fits all type of mentality.
Thoughts? Opinions? So how does your NICU handle vaccines?
Wow! I really rambled here. Didn't mean for this to be so long. Thanks for reading.
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- Jul 28, '12 by NicuGalOur guidelines are the kids need to be at least 1500gms and 2 months old to start vaccines. There is a lot of different opinions on this. If they are a chronic sick kid, we hold off. The one the docs really want the kids to get is whooping cough once they meet the requirement since so many people don't get re-vaccinated. The chronics will get RSV also since if we come to work with a cold, even though we mask, we could still have RSV. If the kid is there long enough to need all the immunizations we break them up over a weeks time so that we give them a break. We found when we gave the chronic lung kids all them at one time it sent them into respiratory distress and were so sick.
- Jul 29, '12 by bmsrnI have personally seen quite a few babies have setbacks after those 2 month immunizations, and it's usually the previous micros. It's to the point now to where we separate those 3 vaccines by 24 hours, so they are given over a 3 day period.
Previously the doctors would write for all of them, and tell us to give them all at the same time. When we would question it they'd go on about how there was no "proof" of babies having setback from the vaccines.
As for the Hep B, we have a weight requirement. I believe it's 2kg.
- Aug 2, '12 by TiffyRNWe frequently put off the 1st Hep B if the infant hasn't reached 1800-2000 grams. In spite of this, we frequently give 2 month vaccines to kids less than 2000 grams and I've seen them given to kids under 1600 grams. Since we stopped giving tylenol we frequently see temperature rises if not true fevers and I've seen some kids (usually the former micros) have a serious set-back. I don't believe it will permanently harm them (brain or immune system) but I do know that these fragile former micros don't take much to set them back and 2 month vaccines will do it (our docs want them given within the same 24hr period so the vaccine record is not confusing).
- Aug 6, '12 by TheMissI practice in Australia as a nurse immuniser (we prescribe and administer vaccinations without medical supervision). All our babies receive their first Hepatitis B vaccine right after birth, even the 23 weeker. There is no evidence whatsoever that vaccinations affect neurodevelopment. There is also no proven benefit for spacing vaccinations over several days and it's not recommended. Vaccinations, do not overwhelm the immune system, and the vaccinations given at birth, 2 4 and 6 month are all not live vaccines. It has however been noticed that some vaccinations can lead to an increase in apnoea in some neonates.
Also, there is to date no RSV vaccine available. It's RSV immunoglobulin we are giving.
- Aug 6, '12 by NicuGalWe do use an RSV vaccine here. We used to give the immunoglobulin, but that required an infusion over several hours in an outpatient setting once a month. I have to beg to differ, but 27 years of experience have shown me, and many others, that the more chronic kids don't tolerate all the vaccines at once, and here in the states, we can give them all individually instead of giving the combines. We don't use live vaccines here, except for chickenpox. While what we give aren't live viruses, they do stimulate the immune system and in some kids cause a negative response, esp our kids with BPD who were on steroids and are just fragile to start with.
- Aug 7, '12 by TheMissQuote from nicugalthere is no licensed rsv vaccine! - the immunoglobulin given at the moment is a simple injection (synagis (palivizumab)). it used to be a long infusion but those days are long gone. many nurses confuse the immunoglobulin injection with a vaccine though. and just fyi the us immunisation schedule includes mmr at 12 month - which is a live vaccine as well. and you can't give them all individual. dtap for example is always 3 vaccinations in one.we do use an rsv vaccine here. we used to give the immunoglobulin, but that required an infusion over several hours in an outpatient setting once a month. i have to beg to differ, but 27 years of experience have shown me, and many others, that the more chronic kids don't tolerate all the vaccines at once, and here in the states, we can give them all individually instead of giving the combines. we don't use live vaccines here, except for chickenpox. while what we give aren't live viruses, they do stimulate the immune system and in some kids cause a negative response, esp our kids with bpd who were on steroids and are just fragile to start with.
- Aug 7, '12 by GreenkjiAs I was reading this thread I'm remembering my son at his 2 month appointment. He was 2 months early and came home 2 days before his due date. The only shot he received in the NICU was the RSV immunoglobulin. I was very weary of giving him vaccinations, even at two months as he had had many surgeries and other problems, but his pedi said as long as he was 2 kilos it was fine. I don't think they would have given him any if he was weighed less.
- Aug 7, '12 by TiffyRNMy primary is a former 26 weeker and just had his 2 month vaccines last weekend. A few hours later he started having multiple apnea/bradycardias that required him to increase his NC flow from 1/2Lmin to 3L/min and slowing his gavage feeds to be given over 90 minutes (they were over 30mins) as well as skipping PO attempts for a couple of days.
Another child in the same room is demographically similar to him (former micro, white boy, but on higher flow O2, roughly same size and adjusted gestational age). This other child's father (a physician) insisted he receive his vaccines as one injection a week (granted one of the shots was the pediarix which is about 5 vaccines in one). So far this other child had no set-backs. That is all I'm saying. Not that the vaccines are harmful in that they cause neurological damage, but when given all at once they make these delicate former micros feel really yucky and I often see the reaction my primary had. It will probably take him a week to make up the set-back his vaccines caused.