IMMUNIZATIONS

All infants who reach age eight weeks while in the NICU should receive their first set of immunizations. These include DTaP (diptheria, tetanus, acellular pertussis), Haemophilus b conjugate, IPV (Inactivated Polio Vaccine - not oral Polio vaccine), and hepatitis vaccine (either Engerix-B or Recombivax). Each of these immunizations can be given concurrently. Subsequent doses of DTaP, Haem B and IPV are administered at ages four and six months. Infants who are admitted directly from home (i.e., who have been outpatients) are excluded, and immunizations are assumed to be the responsibility of their primary physician.

If the mother is HBsAg negative, the dosing schedule for hepatitis vaccine should be at 2, 4, and 6-18 months of age (if discharge occurs before 2 months of age, the hepatitis vaccine should be given at discharge). If the mother is HBsAg positive or unknown, hepatitis vaccine should be given within 12 hours of birth , 1 month and 6 months. HBIG should be given within 12 hours if the mother is HBsAg positive or unknown (HBIG is not repeated with the subsequent vaccine doses); the HBIG dose may be given up to one week if there is a delay in determining the mother's status.

If infants are admitted as transfers to Children's Hospital, it is the responsibility of the admitting NNP or house officer to check with the referring hospital to determine maternal HBsAg status.

DTaP and Haemophilus B at 2, 4, and 6 months

IPV (IPV or OPV can be given after discharge) at 2, 4 and 6 months

HEPATITIS B VACCINE Immunization Schedule	DOSE #	AGE
HBsAg Negative mother*	1 2 3	Discharge or 2 months 4 months 6-18 months
HBsAg Positive motherÝ	1 2 3	0-12 hours 1 month 6 months

• *Alternative schedule: dose #1 at 0-2d., dose #2 at 1-2mo., dose #3 at 6-18mo.
• ÝHBIG should also be administered within 12 hours of birth
• In patients <2kg, the initial vaccine dose should not be counted as one of the 3 required doses (a total of 4 doses are required to complete the series).

HEPATITIS B VACCINE Dose	Recombivax HB	Engerix-B
HBsAg Negative mother	0.25 ml	0.5 ml
HBsAg Positive mother	0.5 ml	0.5 ml

• When the mother is positive 0.5 ml HBIG is also given

NEWBORN METABOLIC SCREEN

Newborn screens may be drawn prior to 24 hours of age, but will require a repeat prior to discharge.

Abnormal Congenital Adrenal Hyperplasia Screen

It is expected that a certain per cent of premature newborns will have a borderline or abnormal CAH screen. If the initial screening is abnormal, a second state screen (filter paper test) should be sent two weeks after the original one. If this second screen is also abnormal or borderline, a quantitative 17-hydroxyprogesterone should be done. Please be sure to note this on the discharge summary form, as the referring physician will most likely need to follow-up this result.

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