The issue of vaccinations is one of the hottest and most controversial. Each side makes its own arguments, but when it comes to vaccinating premature babies, the debate becomes even more intense. The chief physician of the Rassvet children's clinic, Natalya Rashidovna Vasilyeva, answers questions regarding vaccination of premature babies, and four mothers of “early” children share their experience.
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Moms' experience
Lana, three children - all born at 32 weeks:
“All my children, the same age, rushed to be born prematurely. I don’t know why this happened, but three people had to be rehabilitated in different ways. I am a doctor myself, I work with children left behind in orphanages - precisely those who need to be developed long and hard so that one day they can catch up with their peers.
It would never occur to me to doubt the advisability of vaccinations: just look at the mortality statistics before the invention of vaccines, and it will immediately be clear that humanity has made a huge step forward, having learned to vaccinate against the most serious diseases.
I vaccinated all my children strictly on schedule, and I believe that premature babies need this protection even more than others. The only thing is that you need to very carefully monitor the child’s condition on the day of vaccination so that the immune system is not weakened by an infectious disease. If it is present - even in a minimal form - it is better to postpone the procedure to another day, when the baby is completely healthy.
Ksenia, two children, born at 31 and 38 weeks:
“With my eldest son, at first I didn’t want to get vaccinated. Friends were scared with “horror stories” - one’s child seemed to almost stop walking after vaccination, another had a fever for a long time. Lesha grew up weak and sickly, so the doctors gave him medical advice - and I was glad about that. When my daughter was born, in her second month, I had to go to the hospital with my eldest. We lay there for a long time, I expressed milk, our dad came several times a day and took it to feed Lena. While we were being treated, dad consciously gave his daughter all the necessary vaccinations.
At first I was upset, and then we got an appointment with a competent specialist. He began to convince me, saying that I see the problem in a completely different place than where it exists - and my son still needs to be vaccinated. For some reason, I believed him - it seems to me that those who talk about the dangers of vaccination are either exaggerating or unconsciously distorting the facts. The reaction may occur to a bad vaccine, or may be the result of the child being ill at the time of vaccination. In general, I began to harden my son, by the age of three he had caught up with his peers in terms of his development, and now we will get vaccinated along with everyone else.
Karina, daughter was born at 33 weeks:
“Apart from low weight and height, my daughter had no other signs of prematurity—they spent three weeks in the maternity hospital and were discharged home. My mother immediately began to convince me that the girl was weak, and therefore vaccinations would harm her. I invited my mother to the pediatrician - I myself had doubts. Mom, by the way, is a doctor herself, albeit a dentist.
After a half-hour lecture, it became clear that my mother’s ideas about vaccines come from the last century - then everything was indeed a little different, although in the technical part. Therefore, I started vaccinating my daughter immediately after her weight reached the “safe” mark for babies. There was never any reaction, the child was cheerful and cheerful. We grow, we learn to enjoy the world. Everything is fine.
Irina, daughter was born at 36 weeks, son at 34 weeks:
“I didn’t vaccinate my daughter, the birth was at home, and I, in general, was a supporter of everything natural and natural. In principle, everything was fine - the girl was gaining weight well, began to walk and talk quite early, and was not sick in any way, although I was then a convinced vegetarian and, of course, she did not eat meat either.
And then our son was born - and we were faced with a serious problem. Immediately after we left the maternity hospital, we learned that we would have to run around to hospitals for tests. Our housemates were diagnosed with tuberculosis and we all had to be tested because we were constantly in contact with their children. The doctors were very angry at me then - fortunately, everything worked out, and we all turned out to be healthy, but I was so scared that I immediately got all the vaccinations - and continue to do so.
Vaccinations for premature babies.
Premature babies need vaccinations! Infections are very dangerous for young children, so it is especially important to protect the child in the first year of life.
An absolute contraindication to starting BCG vaccination is a child weighing less than 2 kg. Also Hepatitis B (according to some recommendations - weight <2 kg, according to others - <1.5 kg). As soon as the baby “catch up” in weight, the doctor will remove this contraindication.
Relative contraindications: ⁃ Acute diseases ⁃ After blood transfusion and administration of immunoglobulins (6 weeks) ⁃ The child receives a rehabilitation course of therapy (opinion of Yu.V. Miller)
The full list of contraindications can be found here: https://rospotrebnadzor.ru/documents/details.php…
Medical advice from vaccinations is most often given by a neurologist if the child has serious problems (for example, epileptic activity). A non-progressive disease of the nervous system with basic therapy from a neurologist is not a contraindication for vaccination. For children with neurological problems, vaccination against pneumococcus, Haemophilus influenzae, and meningococcus is mandatory.
A reaction can occur to any vaccine (not to be confused with a side effect!). allergic reaction - therefore, after vaccination, the doctor asks you to wait 20-30 minutes in the clinic in order to relieve allergies in case of pain at the injection site (how to relieve pain - slide in the carousel) increase in body temperature within 1-3 days after vaccination rash. In the case of the measles, rubella and mumps vaccine, the reaction may be delayed - from 7 to 14 days.
Almost all vaccines can be combined with each other. The exception is the tuberculosis vaccine (BCG, BCG-m). If you did not have time to get BCG before 2 months, it is installed ONLY after checking the Mantoux reaction.
The Mantoux reaction is not a vaccination - it is a test for the presence of antibodies in the body. The Diaskin test does not replace the Mantoux test, but only complements it in terms of diagnosing tuberculosis.
Mandatory vaccinations made in accordance with the Russian national calendar protect against 12 dangerous infections (graph in the carousel): ⁃ Viral hepatitis B ⁃ Tuberculosis ⁃ Pneumococcal infection ⁃ Whooping cough ⁃ Diphtheria ⁃ Tetanus ⁃ Poliomyelitis ⁃ Haemophilus influenzae ⁃ Measles ⁃ Rubella ⁃ Mumps ⁃ Flu (from 6 months)
Premature babies most often lag behind the national calendar, in which case the pediatrician will select a catch-up vaccination schedule for you.
Important vaccines that have not yet been introduced into the Russian national calendar, but which are in the national calendars of Europe, Great Britain, the USA, Australia (alas, we can only supply them for a fee) ⁃ against rotavirus (Rotatek, first vaccination before 12 weeks of life !) ⁃ against chickenpox (Varilrix, allowed from 12 months) ⁃ against meningococcus (Menactra, allowed from 9 months) ⁃ against the human papillomavirus (HPV causes cervical cancer! - Gardasil, allowed from 9 years, put before the onset of sexual activity )
There is a so-called cocoon vaccination, when ALL adults and children surrounding a prematurely born child are vaccinated with current vaccines. _______ If you have questions related to premature birth and prematurity, call the “Right to a Miracle” Hotline - 8 800 555 29 24. 24 hours a day, the call is free.
Doctor's opinion
Natalya Rashidovna, let’s explain to all parents once again: why do premature newborns need vaccination even more than full-term ones?
A premature newborn baby, as a rule, is more susceptible to infections due to the fact that he is forced to spend more time in medical institutions and, therefore, has more contact with others than a full-term one. Therefore, it is important not to delay vaccination and not to come up with fantastic reasons not to carry it out.
At what age is vaccination of premature infants indicated, what factors must be met in order to give such a child the first vaccination?
Vaccination of newborns begins from the first day of life. The limitation for vaccination can only be technical - it is physically impossible for a very premature baby to be vaccinated against tuberculosis (BCG), since the vaccine is administered only intradermally, and the thickness of such a baby’s skin is thinner than a needle. Therefore, it is recommended to postpone vaccination against tuberculosis until the weight reaches 2000 g. Inactivated vaccines that are administered intramuscularly can be used as usual.
Is the vaccination schedule for a premature baby different from the schedule for a full-term baby? In what cases can it be adjusted?
The vaccination schedule is no different for premature and full-term infants. Children born with extremely low body weight are recommended to use the drug Synagis - this is not a vaccine, but a drug of monoclonal antibodies that allows them to obtain protection against the RS virus, which is especially dangerous for premature babies and children with some complex conditions and diseases.
Let's talk directly about vaccines: are there special vaccines for premature babies, are doses reduced, or is everything done the same as for full-term babies?
There are no special vaccines for premature babies. Many years ago, premature babies were given BCG-M, and full-term babies were given BCG. Now BCG-M is administered to everyone, regardless of gestational age.
How do premature babies usually cope with vaccinations?
Premature babies tolerate vaccinations in the same way as full-term babies.
Are there any special recommendations/exceptions regarding vaccination of preemies?
The main recommendation is full vaccination.
Features of vaccination against hepatitis B: is the vaccination given immediately after birth, like a full-term baby? What do they do if the mother is a carrier of the virus?
Vaccination of premature infants with inactivated vaccines (this includes the hepatitis B vaccine) is no different from vaccination of full-term infants. Moreover, given the high probability of using donated blood in treatment, vaccination against hepatitis B is vital.
If the child's mother is sick or is a carrier of the hepatitis B virus, her baby is at risk and must be vaccinated with 4 doses of the vaccine - there are no differences from full-term babies either.
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Experts: Natalya Rashidovna Vasilyeva
Proper vaccination of a premature baby
There is no doubt that vaccination (introduction of weakened pathogens into the body) of an “early” child should be carried out with extreme caution and according to an individual schedule.
Standard procedure
To schedule vaccinations for a baby who hastened to come into this world, the neonatologist first conducts an examination and issues a conclusion on the gestational age (degree of prematurity), which determines the degree of readiness of all systems and individual organs for extrauterine presence.
The neonatologist’s conclusion includes data on the baby’s condition, the presence of any genetic diseases in the family, birth injuries, and the level of risk of infectious diseases. And based on all this, a vaccination schedule is drawn up. In most cases, it is practically no different from the National Vaccination Calendar, which regulates the vaccination of infants born at term. They are given the vaccine in the same dosages, changing only the time of the procedure.
Vaccination to protect against hepatitis B
The procedure is not very different from the standard one. If the mother of the newborn is healthy and does not suffer from this disease, vaccination is carried out according to the standard scheme: three intramuscular injections into the outer surface of the thigh in front - in the first 24 hours of life, at 1 month and six months later.
It is necessary that two conditions coincide: the weight of the premature baby does not exceed 2 kg and the mother is a carrier of the virus or has not been tested for infection with hepatitis B. Such children are given an injection in the first 12 hours after birth, accompanied by a special immunoglobulin against hepatitis of this group.
Further introductions of the weakened virus are carried out at the ages of 1 month, 2 months and 1 year. In this case, redness and slight swelling at the injection site may be observed for several days. After 2-3 days, all unpleasant effects disappear.
Tuberculosis will not go away
For normal and premature babies, the BCG vaccine is administered subcutaneously 3-7 days after birth. The exception is those born prematurely and weighing less than 2 kg. They are vaccinated against tuberculosis just before discharge from the maternity hospital, when they have reached a weight of 2300 g. If there are any additional contraindications, they are given an injection at the district clinic after they have been removed.
What about diphtheria, whooping cough, tetanus and polio?
The introduction of weakened pathogens of whooping cough, diphtheria and tetanus (DTP) for “early” children is always carried out according to an individual program. To do this, determine the presence, type and degree of damage to the nervous system (mandatory consultation with a neurologist), take a general urine test and, based on this information, prescribe vaccination. Most often it is made with an ADS drug that does not have the most aggressive component - whooping cough. Vaccination against polio is carried out with an inactivated drug. This is due to the need to avoid the appearance of the pathogen in feces.
And definitely against the flu
All babies born earlier than expected and with identified respiratory disorders need flu vaccinations. They are done when they reach the age of 6 months.
