Vaccinations in the NICU

NicuGal, MSN, RN · Jul 28, 2012

Our 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.

bmsrn · Jul 29, 2012

I 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.

TiffyRN, BSN, PhD · Aug 2, 2012

We 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).

TheMiss · Aug 6, 2012

I 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.

NicuGal, MSN, RN · Aug 7, 2012

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.

TheMiss · Aug 7, 2012

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.

there 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.

Greenkji · Aug 7, 2012

As 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.

TiffyRN, BSN, PhD · Aug 7, 2012

My 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.