A 6-week-old boy is seen in the office for routine follow-up after discharge from the neonatal intensive care unit. He was born at 31 weeks gestation to a 41-year-old woman via cesarean delivery for preeclampsia with severe features and breech presentation. The hospital course included brief oxygen supplementation via continuous positive airway pressure and nasal cannula and phototherapy for jaundice. The patient is now breastfeeding every 3 hours and gaining weight appropriately. Maternal prenatal laboratory studies were normal. Weight today is 3 kg (6.6 lb). Examination is unremarkable. The parents inquire about upcoming vaccines for their infant. Which of the following is the most accurate statement regarding immunization scheduling for this patient?
A)Immunizations are given according to the chronologic age
B)Immunizations are given according to the corrected gestational age
C)Immunizations are given when antibody testing confirms an immune response
D)Immunizations are given when weight ≥4 kg (8.8 lb)
E)Toxoid vaccines are given according to chronologic age, but live attenuated vaccines are given according to corrected gestational age

Question

A 6-week-old boy is seen in the office for routine follow-up after discharge from the neonatal intensive care unit.  He was born at 31 weeks gestation to a 41-year-old woman via cesarean delivery for preeclampsia with severe features and breech presentation.  The hospital course included brief oxygen supplementation via continuous positive airway pressure and nasal cannula and phototherapy for jaundice.  The patient is now breastfeeding every 3 hours and gaining weight appropriately.  Maternal prenatal laboratory studies were normal.  Weight today is 3 kg (6.6 lb).  Examination is unremarkable.  The parents inquire about upcoming vaccines for their infant.  Which of the following is the most accurate statement regarding immunization scheduling for this patient?
A)Immunizations are given according to the chronologic age
B)Immunizations are given according to the corrected gestational age
C)Immunizations are given when antibody testing confirms an immune response
D)Immunizations are given when weight ≥4 kg (8.8 lb)
E)Toxoid vaccines are given according to chronologic age, but live attenuated vaccines are given according to corrected gestational age

Quizplus · Accepted Answer

11ec25c8_d627_76a6_bc81_5d8a537f28f3_MD0003_00 Premature infants are at high risk of complications from vaccine-preventable diseases due to immature immune systems. Vaccinations for preterm infants should not be delayed; they are safe and proven to induce an adequate antibody response to confer immunity. In addition, mild intercurrent illness is not a contraindication to vaccination. Therefore, medically stable premature infants should receive routine immunizations on the same schedule as full-term infants, based on their chronologic age (age since birth). This patient's chronologic age is 6 weeks, so he should receive the hepatitis B (second dose), rotavirus, tetanus, diphtheria, acellular pertussis, Haemophilus influenzae type B, pneumococcal, and inactivated polio vaccines at 2 months chronologic age. (Choice B) Corrected age, or age adjusted for gestation, is considered when assessing a premature infant's growth and developmental milestones, but it does not determine timing of vaccine administration. (Choice C) Preterm infants can mount appropriate immunologic responses to vaccines. Measuring titers of IgG antibodies to evaluate responsiveness to antigens is unnecessary. (Choice D) The first hepatitis B vaccine is administered when the patient weighs ≥2 kg (4 lb 6 oz), typically at birth. All other vaccines are administered based on chronologic age. (Choice E) Live attenuated vaccines are withheld in immunocompromised patients. This infant displays no signs of immune compromise, so all vaccines can be administered based on chronologic age. The first dose of live measles, mumps, rubella, and varicella vaccines is typically administered around age 1 year. Educational objective: Preterm infants should receive routine immunizations according to chronologic age rather than age corrected for gestation. Live virus vaccines are withheld in immunocompromised patients, but mild intercurrent illness is not a contraindication to vaccination. References: Immunization of preterm infants. (http://www.ncbi.nlm.nih.gov/pubmed/26291883)

A 6-Week-Old Boy Is Seen in the Office for Routine