Vaccination reduces the risk of infectious diseases and mortality in premature babies

The calendar follows the chronological age and must be respected by parents and doctors

By Cristiane Bomfim, of the Einstein Agency – Considered one of the most effective means of combating infectious diseases, vaccination is an important tool for health and the reduction of deaths in the first years of life among children born prematurely. This is because the lower the gestational age, the less developed the immune system is at birth. Babies born less than 28 weeks’ gestation, for example, have a 5 to 10 times greater risk of contracting an infectious process. Even so, according to the Brazilian Society of Pediatrics (SBP), vaccine delay rates in Brazil in this group range from 30% to 70%, with an average delay time of between 6 and 40 weeks.

According to a paper published by SBP with guidelines for pediatricians and neonatologists, one of the main reasons for postponing or delaying vaccination of preterm babies is the lack of knowledge about how the immune response works in these newborns. Vaccines stimulate children’s specific immunity, which is exerted by antibodies. “Despite having a more immature immune response in relation to the term infant, preterm infants usually respond well to vaccines, doses and intervals,” says Vitor Nudelman, pediatrician and immunologist at the Israelite Albert Einstein Hospital in Sao Paulo.

Vaccination of premature babies follows the same schedule as full term babies. The exception is the BCG-ID vaccine, which should only be given after the infant has reached 2 kg. In addition, we should take an extra booster dose of the hepatitis B vaccine one month after the first dose, following the schedule 0 – 1 – 2 and 6 months.

Adverse reactions

According to SBP, there are no contraindications to vaccinating premature babies, as long as they are not in unstable clinical conditions or with an ongoing infectious process, but it is important to carefully monitor the baby at the time and hours after immunization to treat any adverse reactions.

There are medical reports showing that the application of the triple whole cell bacterial vaccine (which protects against pertussis, diphtheria and tetanus) in premature infants with gestational age less than 31 weeks is associated with an increase in apnea and seizures. “Therefore, the recommendation is that premature babies preferably receive the triple acellular vaccine, which is made with protein rather than whole cells and offers fewer adverse reactions,” says Nuldeman.

For the pentavalent vaccine (which protects against diphtheria, tetanus, pertussis, poliomyelitis and Haemophilus and influenzae type B) given to preterm infants at 2 months of age, cardiorespiratory events were recorded after application, such as decreased heart rate and apnea with variable percentages from 11% to 47% based on gestational time. “Strategies such as the use of non-hormonal anti-inflammatory drugs, such as the administration of ibuprofen, thirty minutes before vaccination, appear to decrease the number of cardiorespiratory events related to the pentavalent vaccine,” the doctor said.

Factors that increase the chances of infectious diseases in premature babies:

• The true cause of preterm birth, urinary tract infections and other maternal infectious diseases;
• Smaller airways, making them more vulnerable to respiratory infections
• Lower energy reserve;
• Early weaning;
• Frequent infections;
• Chronic lung disease of prematurity;
• Need for frequent catheters and punctures;
• Prolonged hospitalization;
• Anemia;
• Frequent use of corticosteroids;
• Use of blood products and transfusions.

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