Tag: NICU

Do Preemies Frequently Crash After They Get Their Hep B Shot?

Why do some folks think that preemies frequently crash after they get their Hep B shot?

Do you think that Michael Master, a chiropractor, has spent much time in the NICU?
Do you think that Michael Master, a chiropractor, has spent much time in the NICU?

Because it is a common anti-vaccine myth that they do…

Do Preemies Frequently Crash After They Get Their Hep B Shot?

We hear it over and over from the usual suspects.

Did a NICU nurse tell her about the crash carts???
Did a NICU nurse tell her about the crash carts???

And they have been posting about it for years.

Who are these NICU nurses that tell these stories?
Who are these NICU nurses that tell these stories?

It is always the same story too, that they have heard stories from NICU nurses that they get crash carts ready before giving preemies their vaccines.

Vaccines do not slow breathing down...
Vaccines do not slow breathing down…

Crash carts?

That we keep seeing these posts about NICU nurses, but never a post from a NICU nurse should tell you something...
That we keep seeing these posts about NICU nurses, but never a post from a NICU nurse should tell you something…

A crash cart or code cart is a self-contained, wheeled cart with trays and drawers that include all of the supplies you need in a medical emergency.

I have worked in a lot of NICUs and have never seen anyone get a crash cart ready when vaccinating a baby...
I have worked in a lot of NICUs and have never seen anyone get a crash cart ready when vaccinating a baby…

Of note, none of these posts are actually from neonatologists or NICU nurses.

They are all from folks who had supposedly read or heard about the posts from the NICU nurses, but in reality, they are likely familiar with them because it has become a common anti-vaccine talking point.

As I’m sure you have guessed, they aren’t true.

Premature babies do not frequently crash after getting their hepatitis B vaccine

For one thing, premature babies do not frequently crash after getting their hepatitis B vaccine.

“Vaccines are immunogenic, safe and well tolerated in preterm infants. Preterm infants should be vaccinated using the same schedules as those usually recommended for full-term infants, with the exception of the hepatitis B vaccine, where additional doses should be administered in infants receiving the first dose during the first days of life if they weighed less than 2000g because of a documented reduced immune response.”

Gagneur et al on Immunization of preterm infants.

The hepatitis B vaccine is safe, with few side effects.

Anyway, crash carts are always ready and nearby in the NICU!

These babies are in an Intensive Care Unit, so you are always ready and prepared for them to crash, doing everything you can to prevent that from happening.

More on Hepatitis B Vaccine Safety

More Misinformation on Vaccine Shedding

Do you know why folks still think that vaccine shedding is a problem?

Misinformation on vaccine shedding keeps spreading on Facebook.

Yup. Folks keep posting and sharing misinformation about vaccine shedding!

More Misinformation on Vaccine Shedding

Are these real signs that are warning people about shedding?

Maybe, but that doesn’t mean that they are accurate.

Smallpox Warning Sign
You actually aren’t supposed to swim after getting the smallpox vaccine, but just until the vaccination site has healed, in 3 to 4 weeks.
Outdated Information
Outdated Information
John's Hopkins Patient Visitor Guide
The updated patient visitor guide from John’s Hopkins.
Outdated Information
Outdated Information
The latest Patient Visitor Guidelines from St Jude
The latest Patient Visitor Guidelines from St Jude
Do Not Visit
Not visiting within 30 days of a live vaccine is not part of any guideline.
Chickenpox Vaccine Shedding Sign
Unless you have a rash, you can not give your child chickenpox after getting vaccinated.

Are some places overly cautious or just not up-to-date on the current guidelines on vaccine safety?

If you read the latest guidelines it is clear. Vaccine shedding is rarely a problem when visiting most people in the hospital.

More on Misinformation on Vaccine Shedding

Vaccines for Premature Babies

It is easy for the parents of a premature baby in the NICU to get overwhelmed by all of the things that might be going on, especially if they are there long enough for their baby to get their two month vaccines.

Premature babies can usually get all vaccines on schedule - at their chronological age, not an adjusted age based on being a preemie.
Premature babies can usually get all vaccines on schedule, at their chronological age, not an adjusted age based on being a preemie. Photo by Vincent Iannelli, MD

Ventilators, TPN, jaundice lights, feeding tubes, oxygen, apnea monitors, etc. – is this really a time to be thinking about vaccines?

Since premature babies can have an immature immune system and are at greater risk for infectious diseases, including vaccine-preventable diseases, it is actually a great time to make sure that your baby gets vaccinated and protected.

Vaccine Recommendations for Preterm Babies

What vaccines do premature babies need?

Which ones should you delay or skip?

“In the majority of cases, infants born prematurely, regardless of birth weight, should be vaccinated at the same chronological age and according to the same schedule and precautions as full-term infants and children”

ACIP Vaccination of Premature Infants

Not surprisingly, it is recommended that you not delay or skip any vaccine just because your baby was born premature.

You also shouldn’t wait to vaccinate your preterm baby according to any corrected or age-adjusted schedule. Premature babies get vaccinated according to their chronological age, just like everyone else.

There is one exception.

If a preterm baby also has a birth weight less than 2,000g AND their mother is known to be negative for hepatitis B infection, then they can delay their first dose of hepatitis B vaccine until they are 1 month old or at hospital discharge (whichever is sooner). The hepatitis B vaccine can be safely given if the mother is hepB positive or her status isn’t known. That dose just isn’t counted and is later repeated, because of the concern that it might not work as well in low birth weight, premature newborns.

Vaccines Work for Premature Babies

Does that mean that other vaccines for premature babies might not work as well either?

Many studies have shown that vaccines work well in premature babies.

The World Health Organization does recommend that for Prevnar, “pre-term neonates who have received their 3 primary vaccine doses before reaching 12 months of age may benefit from a booster dose in the second year of life.” That doesn’t apply in the United States though, as we give a routine booster to all toddlers at 12 to 15 months and studies have shown this schedule works well for preterm babies. That’s good, because preterm babies are thought to be at much higher risk for invasive Streptococcus pneumoniae infections.

Otherwise, remember the advice of the AAP, including that “medically stable preterm babies weighing more than 4.4 lbs. at birth should be treated like full-term babies and receive the first dose of the hepatitis B immunization according to the recommended schedule.”

What To Know About Vaccines For Your Preterm Baby

Vaccines are safe, effective, and very necessary for premature babies.

More About Vaccines For Your Preterm Baby