Best practice for Hep B vaccine

Jolie, BSN · Sep 17, 2008

Unless the infant is born to a mother with known Hepatitis B infection, there is absolutely no reason to give that vaccine within the first few hours of birth. I am pro-vaccine, but even I think it is ridiculous to insult a newborn and interfere with bonding to give a vaccine that can safely be delayed for hours, days, months, possibly even years (in most cases).

The rationale of giving it in the immediate newborn period for the purpose of "evening out" the workload is downright objectionable, and will only lead to problems. How in the world can a newly-delivered couple possibly be expected to give informed consent when they are focusing on stabilization, meeting their baby, bonding, breastfeeding, etc.? There will be parents who OK the shot, confusing it with Vit. K. You will end up with a backlash of parents who believe they were tricked into the vaccine, or worse yet, don't even know their baby received it.

Post-partum has mom-baby couplets for the better part of 2 days, and can't fit in the time for a vaccine?

I agree with you, this is nuts!

Elvish, BSN, DNP, RN, NP · Sep 18, 2008

I see absolutely no reason to give the HepB vax in the immediate newborn period. Heck, I see no reason to give it at all in babies' first few days. Where I am, nursery does eyes/thighs after the first hour. Nobody worries about HepB til after mom has seen her baby for a while. I tell parents it's not something they have to do right then, if they want to wait til baby's a few months old that is perfectly w/in their right. A lot of parents take me up on that.

Even if mom is HepB + you still have 12 hours to give the Hep/HBIG so don't see what the rush is to do it immediately.

lisamct · Sep 20, 2008

Can I just ask why the need to give newborns the Hep B vaccine at all? Im a midwife in the UK and have never heard of giving babies the Hep B vaccine.

Im guessing its because Hep B is so common in the US? (although Ive no idea if this is true either)

Jolie, BSN · Sep 20, 2008

can i just ask why the need to give newborns the hep b vaccine at all? im a midwife in the uk and have never heard of giving babies the hep b vaccine.
im guessing its because hep b is so common in the us? (although ive no idea if this is true either)

http://aapnews.aappublications.org/cgi/content/full/e2006200v1

academy (american academy of pediatrics) endorses cdc's hepatitis b recommendation

the academy has endorsed the centers for disease control and prevention (cdc) recommendation for hepatitis b vaccine, a comprehensive immunization strategy to eliminate transmission of hepatitis b virus infection in the united states. the cdc recommends that all newborns receive a birth dose of hepatitis b vaccine before leaving the hospital unless a physician provides a written order to defer the birth dose. cdc also recommends that all children age 19 and younger receive the vaccine series.

these are the official recommendations of the aap and cdc. many school districts require hepatitis b vaccination for school entry. is there any good, sound justification for this recommendation for most healthy newborns born to hepatitis (-) mothers? probably not. it is my understanding that the recommendation has more to do with greater likelihood of compliance since it dovetails with regularly scheduled infant well-visits (birth, 1 month, 6 months) than with a need for protection at that age.

mugwump · Sep 20, 2008

I get all that i can find when it is given before discharge what i can't find is any reason not to give it at 2 hours of birth. (granted i don't want to i think it is wrong but i am trying to find evidence to support by decision) the academy of pediatrics doesn't help me or hur me on this one. the baby is getting it prior to discharge from the hospital post partum just wants it 2 hours or before after birth. :banghead: when was nursing practice fair when did you have to give up a bath and take on something else so it is fair. I thought it was all about patient care and best practice. I guess i was wrong. :sniff:

Jolie, BSN · Sep 20, 2008

Perhaps you could go to your lactation consultants for information about best practices to support bonding and breastfeeding.

Also, can you find any research on the effects of unnecessary stressors on blood glucose maintenance, or increased risk of respiratory distress?

OzMW · Sep 26, 2008

Giving Hep B just after birth annoys the hell outta me - we do it too! Its a load of rubbish - but having said that BF is a great pain reliever - so skin to skin with mum and attached at the breast is probably the best way to give a neonate a painful injection!

OzMW · Sep 26, 2008

Can I just ask why the need to give newborns the Hep B vaccine at all? Im a midwife in the UK and have never heard of giving babies the Hep B vaccine.
Im guessing its because Hep B is so common in the US? (although Ive no idea if this is true either)

We do it here in Australia unfortunately...its because neonates are high risk for Hep B - you know all that newborn IV drug use and promiscuous sexual activity!!!!!!!:smokin:

MommyandRN · Sep 27, 2008

I am not an OB nurse (not yet at least, work with adults right now). But about the Hep B shot - we had my first get it right away but my second waited. I really thought alot about it and figured the baby was not using IV drugs or having sex.... they don't need it until they are older.

Also this is a NEW recommendation, and we don't know what giving babies these vaccines that early will do to their immune systems yet. I think the CDC's goal is to eradicate Hep B like they did with polio etc. just because they have the vaccine and want to see what will happen in 50 years if they vaccinate all newborns - "look what a great thing we did here." But the thing is, Hep B is usually not even life-threatening anyway. Most people live for many years with it.

OzMW · Sep 28, 2008

I am not an OB nurse (not yet at least, work with adults right now). But about the Hep B shot - we had my first get it right away but my second waited. I really thought alot about it and figured the baby was not using IV drugs or having sex.... they don't need it until they are older.
Also this is a NEW recommendation, and we don't know what giving babies these vaccines that early will do to their immune systems yet. I think the CDC's goal is to eradicate Hep B like they did with polio etc. just because they have the vaccine and want to see what will happen in 50 years if they vaccinate all newborns - "look what a great thing we did here." But the thing is, Hep B is usually not even life-threatening anyway. Most people live for many years with it.

No mine didn't get it at birth either and very good point about the lack of knowledge in regards to long term effects! There have got to be better ways of eradicating this disease, The world has gone mad - what will we be vaxing against next? And I am pro vax and my kids have had there full schedules (apart from varicella which is another dubious one!)

jhhrn68 · Oct 3, 2008

I am not a big proponent of early vaccines for infants. Their immune systems are not that well developed. The only reason to give Hep B to newborns is that they are a captive audience. Breast feeding will protect the little ones from many diseases through immunity in the mother's milk. If only more people would breast feed.......