Is Your Preemie More Susceptible to a Virus?
Normally, newborn infants have two ways to fight off viruses. One is from the antibodies their mothers produce to viral infections. These antibodies pass to the baby through the placenta. However, this happens in the late stages of pregnancy, so premature babies will not have as much protection as full-term infants in this area.
The other protection comes from their own immune systems, which are not fully developed in premature babies. The earlier they are born and the smaller they are, the less developed their immune systems will be.
There are a number of steps parents can take to help prevent viral infections in premature babies. Ideally, the first step should occur before any pregnancy. Women planning on conceiving should be vaccinated against all the appropriate viruses, including those like rubella (German measles), which can cause birth defects. Women who have not received the MMR (measles, mumps and German measles) vaccine should be vaccinated before getting pregnant. There are other recommended vaccines to protect against viruses like hepatitis A and B that may be appropriate for women before pregnancy. There are also vaccines against bacterial infections.
Women should get the yearly influenza, or flu, vaccine before getting pregnant, and even during pregnancy depending on the time of year, and how long it has been since their last vaccination. The influenza virus is very dangerous for pregnant women, and therefore their unborn children. A flu vaccine is needed once a year at the beginning of flu season.
These vaccinations can help prevent illness in the mother. Even if a baby is born prematurely, if the mother does not catch a viral illness, she will not pass it to her baby. For this reason, all adults who will be in contact with the baby should be vaccinated with all necessary adult vaccines well before the birth of the baby. Adults can review this with their own doctors.
Additionally, premature babies must be kept away from children and adults who might pass viral illnesses to them. This means limiting their exposure to other people. There are many viral infections without vaccines to prevent them. These include very serious illnesses, including herpes virus infection and respiratory syncytial virus (RSV). Premature infants are less able to fight these infections off, and they can cause severe illness and even death.
The only physical way to prevent a premature baby from catching a virus is by preventing her exposure to it. Adults taking care of a baby should be well, and should be very careful to wash their hands thoroughly before holding the baby. Parents of a premature baby should ask their doctor when it is safe to take her out in public.
Any sign of illness should lead to a prompt visit to the doctor, or emergency room if the baby seems very sick, especially with an infection in the respiratory system, when the baby is having trouble breathing. There are medications that may help with herpes virus, and there has been some success with a drug called palivizumab, which contains virus-fighting antibodies to RSV, when used during an RSV outbreak for high-risk babies, like those born prematurely.
In general, premature babies should receive vaccines on the same schedule as their chronological age, not their developmental age. The only notable difference is the hepatitis B vaccination. Vaccines recommended to prevent viral infections during the first twelve months of a baby’s life include:
- Polio virus vaccine at ages 2, 4, and 6 to 18 months (booster)
- Influenza vaccine at six months and thereafter yearly during flu season, with two doses the first time
- MMR vaccine at 12 months
- Hepatitis A vaccine between 12 to 23 months with a booster 18 months later
- Hepatitis B vaccine at birth, 1 to 2 months, and 6 to 18 months in term babies
- Rotavirus vaccine at ages two, four, and six months in term babies
Premature babies may not make enough antibodies to the hepatitis B vaccine. Nevertheless, if the mother has the active hepatitis B vaccine in her system or her status is not known, premature babies should get their first dose of the vaccine within 12 hours of birth. Otherwise, they should be vaccinated for the first time at one month. If given, the first dose at birth does not count toward the three vaccines needed. If the mother has active hepatitis B (indicated by a positive test called HBsAg), the baby also needs hepatitis B immune globulin.
The rotavirus vaccine should not be given until a premature baby is going to leave the hospital. If the baby is more than 15 weeks old, the series should not be given. Rotavirus causes severe gastroenteritis in babies, meaning serious diarrhea and vomiting.
There are other vaccines used to prevent bacterial infections, like the Hib vaccine to prevent Haemophilus influenza, or the DTaP to prevent diphtheria, tetanus and whooping cough (pertussis). These are also given to premature infants on the regular schedule.
Hopefully you will get vaccinated before you get pregnant. The best additional strategy to prevent your premature baby from catching a viral illness is to make sure he or she gets all the vaccines suggested above, as well as anything else recommended by the baby’s doctor. Additionally, you should limit the baby’s exposure to other people until they have developed stronger immunity to infection.