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Discussion

Help with newborn immunity question...

Howdy Peds nurses! Adult critical care RN here with a question/need. I'm looking to refute or support the practice of recommending keeping term newborns out of public places up until roughly 6 mo of age. Hoping you folks can point me to evidence-based data/peer-reviewed data. I realize the idea of preterms out in public is irrefutable based upon my own education and limited ability to make good sense of the articles on PubMed, etc.

The end audience for this is myself, several laymen parents ( dad with a 4-day-er in the grocery store specifically) on another forum I frequent, and possibly my own kids' doc who recommends this strongly.

Thanks in advance for any help:heartbeat

Featured Replies

Babies don't make adequate amounts of IgG until about 6 months of age. From birth on, they rely on mom's IgG which is constantly being catabolized until it's almost gone, usually around 10 months.

So although they have some IgG that they make after birth, it's inadequate to mount a sufficient immune response.

  • Experts

Give me a little bit of time and I can pull something together. I can tell you anecdotally that a significant number of our infant PICU admissions for bronchiolitis will be the term neo or infant with siblings, or one that has been dragged through the malls at Christmas time, passed around at the family gathering or left at daycare. Recently one of my coworkers' infants was admitted to our unit with RSV. Term baby, mom's a PICU nurse, knows what she's doing but couldn't deprive her older child of his social interactions at preschool and now the infant (7 weeks old) is intubated, ventilated and on pressors because he's so sick. Fortunately for all of us the baby got better and will be going home in a few days, but it just shows that no one can claim special protection!

  • Author

Thanks both of yooz-guys. I respect my kids' doc tremendously, and it takes pretty compelling evidence to sway me any other way.

I don't agree with him regarding managing plagiocephaly 2nd to torticolis, but I had to hit the books hard on that one to come up with my own reasoning.

I'd much appreciate any www recources you could dig up without too much trouble.

  • Experts

Well, I found a good article on Medscape Nurses that gives a list of top risk factors for hospitalization for RSV... and although the focus of the article is on American Indian children, the risk factors listed are not specific to any population.

http://www.medscape.com/viewarticle/574193

The potential sequelae of neonatal RSV infection can be serious: http://www.rsvinfo.com/sequelae/sequelae.html so why risk it!

eMedicine has a scholarly paper on bronchiolitis with statistics that suggest isolative practices should protect infants from infection:

http://www.emedicine.com/emerg/topic365.htm A telling point is "most deaths occur in infants younger than 6 months".

And this article is more ammunition:

http://www.dcmsonline.org/jax-medicine/1998journals/september98/bronchiolitis.htm

I think these all support keeping babies away from crowds.

  • Author

Thanks for staying with me on this! I'm on the work computer right now, so will digest those links better on Sunday. I poked around a good bit on CDC, AAP, AAFP(??), Mayo, and the like. . I was unable to find anything black-and-white fit for my main audience. We as pro's can filter the message more meaningfully. (You may have already given me my smoking gun, I'm very interested to read your links above)

Thanks again!

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