Hepatitis shots given to micropreemies

NoviceRN10 · Jan 3, 2012

Micro preemies get them? I didn't even let the hospital give it to my fullterm newborns, I waited and let my pediatrician administer it.

Jolie, BSN · Jan 3, 2012

Micro preemies get them? I didn't even let the hospital give it to my fullterm newborns, I waited and let my pediatrician administer it.

Any newborn infant exposed to Hepatitis B during pregnancy needs to receive the vaccine ASAP after birth.

It is not administered as a routine vaccine in a newborn micro preemie.

NoviceRN10 · Jan 3, 2012

Any newborn infant exposed to Hepatitis B during pregnancy needs to receive the vaccine ASAP after birth.
It is not administered as a routine vaccine in a newborn micro preemie.

It wasn't specified which type, as there are more than one.

Jolie, BSN · Jan 3, 2012

It wasn't specified which type, as there are more than one.

There are 2 commonly used brands of Hepatitis B vaccine, Engerix and Recombivax.

Exposed infants also receive Hepatitis B Immune Globulin (HBIG) which offers immediate protection from infection while the infant develops antibodies from the standard vaccine.

Exposed infants need both the Hepatitis B vaccine and HBIG (which really isn't a vaccine, but an immune globulin) within 12 hours of birth.

This poses a legitimate concern, since the muscle mass of micro-preemies is limited and IM vaccines are usually avoided in this population, if at all possible.

I'm not aware of any approved protocol for giving a vaccine IV. Immune globulins are often given IV, but I have no experience with giving HBIG by any route other than IM.

RainDreamer, BSN, RN · Jan 4, 2012

What Jolie said.

If they're not exposed we wait until they are 2 kg before giving them the Hep B vaccine, if parents consent. If they are under 2 kg at discharge, they get it in the peds office.

NicuGal, MSN, RN · Jan 4, 2012

When confronted with that dilemma, we divide up the injection in half and give them 2-4 hours apart. As long as you are within the 12 hour window you are okay. I have never seen it given IV.

For regular immunization, when they are 1800gm and with parental consent we give it.

Julie, OT · Jan 4, 2012

Thank-you so much for your replies. Another question--administering Synagis vaccine--again given IM? I completely agree with the lack of muscle mass, stress/pain.

NicuGal, MSN, RN · Jan 4, 2012

Synagis, they are bigger and ready to go home, at least in our unit. We just give it. We used to do Synagis IV, but once you start the IV you have to continue with it and they have to come in monthy for an IV...not cool. We used to have to go down to outpatient and start IV's all the time, it was horrible. They are much better off with the IM.

Julie, OT · Jan 6, 2012

Wanting to know if anyone has info on best practice on positioning micropreemies at ML as a preventitive to IVH for certain number of days? There's talk going around that there's something out there, but I haven't been able to find evidence for this. Thanks!!

NicuGal, MSN, RN · Jan 7, 2012

They should be placed midline (head not turned to either side) as can cause fluctuations in the blood flow to the brain and cause a bleed. Our kids are in a midline position for 72 hours. We can put them on their sides, but the body and head have to be aligned. No prone, no head side to side. No weights, minimal stim, minimal suctioning, etc. Don't want big fluctuations in BP's. There have been articles in Neonatal network.

babyNP., APRN · Jan 7, 2012

We only give Hep B to ex-preemies that are 2 months old along with their other 2 month old shots and then they just get their second and third Hep B shots a little later than their cohorts.