Immunization schedule for premature baby

Thanks DORJI, its good question. when it comes to immunization schedule for premature babies, I think prematurity is not a contraindication to routine vaccines. so that, premature babies should be given as same chronological age as for full term infant and even no dose reductions needed as well.

although, hospitalized preterm infants particularly those porn <2,000g, should be monitored for apnea/bradycardia for 48 hrs after some vaccines such as 1st dose of DTP containing vaccine.

while, some vaccines should be delayed if the infant weighing <2,000g, like BCG unless at high risk of TB, should be given when the infant weigh is ≥2,000g or clinically stable.

Rotavirus vaccine should also be delayed if the baby is hospitalized due to risk of viral shedding and given after discharge from NICU and before 15 weeks of age. 

HepB may also be delayed until weight is ≥2,000 g unless the mother is HBsAg-positive. If there is a high measles risk, infants may get an early dose at 6 months, but it must be repeated after 9 months.

if available, RSV prophylaxis (palivizumab) is highly recommended for preemies born < 32 weeks gestation. all other vaccines should be given based on the national routine immunization schedule.

That is from my side. Thank you so much.

Thank you sir for your prompt response.

Thank you to the previous poster for a helpful response. Indeed prematurity is not a contraindication to vaccination, however low birth weight does factor in to the recommendations for birth dose vaccinations in particular. National policy on this may vary so please always refer to the guidelines in your country of practice. WHO recommendations are below:

BCG - please refer to the WHO position paper (2018): https://www.who.int/publications/i/item/who-wer9308-73-96

Preterm infants and low birth weight infants – Although evidence is limited, moderate-to-late preterm infants (gestational age >31 weeks) and low birth weight infants (<2500 g) who are healthy and clinically stable can receive BCG vaccination at birth, or at the latest, upon discharge from the neonatal ward to the community. A normal infant dose of BCG should be administered and revaccination is not required. An individual assessment of the clinical condition of other low birth weight infants, in particular very low birth weight and extremely low birth weight infants, will determine the optimal time point for vaccination.

Hepatitis B Birth dose - please refer to the WHO position paper (2017): https://www.who.int/publications/i/item/WER9227

Low birth weight is not a contraindication to vaccination, however, vaccine effectiveness may be reduced. Therefore, these babies will require three additional doses of Hep B (which, in the case of most national immunization programmes, is already included in the 3 dose Pentavalent/Hexavalent schedule, so this is not a problem as long as the full 3-dose Penta/Hexa series is completed). 

Since perinatal or early postnatal transmission is the most important source of chronic HBV infection globally, all infants (including low birth weight and premature infants) should receive their first dose of hepatitis B vaccine as soon as possible after birth, ideally within 24 hours.

This is explained further in this guide, page 10: https://www.who.int/publications/i/item/9789241509831

Immunizations in premature infants are generally given according to chronological age, not corrected gestational age.
BCG is deferred until the infant is clinically stable and weighs at least 2–2.5 kg, depending on national policy.
Hepatitis B vaccine at birth
Given if birth weight is ≥2 kg.
If <2 kg and mother is HBsAg-positive or status unknown: give vaccine + HBIG within 12 hours.
If <2 kg and mother is HBsAg-negative: delay until 1 month or hospital discharge.

DTaP-IPV-Hib-HepB (pentavalent or hexavalent) is given at 6, 10, and 14 weeks (chronological age).
Pneumococcal conjugate vaccine (PCV13 or PCV10) is administered at 6, 10, and 14 weeks.
Rotavirus vaccine is given at 6 and 10 weeks; ensure first dose is given before 15 weeks of age.
Inactivated polio vaccine (IPV) is included in the routine schedule at 14 weeks, as part of combination vaccines.
Influenza vaccine is recommended from 6 months of age, with two doses given 4 weeks apart initially.
Measles-containing vaccines (e.g., MMR or MR) are given at 9 months and again at 15–18 months, depending on national schedules.
Premature infants, especially those with chronic lung disease or congenital heart disease, may be eligible for palivizumab (RSV prophylaxis) during the RSV season.
Monitor for apnea, bradycardia, and desaturation after immunization in very premature infants (especially <28 weeks), usually for 48 hours post-vaccination.