selective and delayed vax for preemies

[boobs4milk]

nak.

i didn't know whether to post this here or on the selective and delayed vax board, so i'll c&p this to both places.

my baby is 3 weeks old, born at 35 weeks, 17 days in nicu for respiratory and some genetic issues and we are headed to our first dr. appt post nicu. i'm sure they are going to start pressuring me to vax. i D&S vaxed my 3 1/2 yr old, skipping flu, chicken pox, prevnar (too new) and delayed mmr. we did all early vax with a 'no more than 2 at a time a month apart' policy and waited until the 2 mo visit to start.

i'm wondering if we should follow suit or be more proactive because she's premature and needs extra immunities or be less proactive because she's premature and may not be able to handle everything?

tia,
jen

[DocsNemesis]

Honestly you'll get a million different answers because everyone has their own ideas, lol. Yes, I can see where preemies are more at risk for certain things and why parents would be extra nervous. Yes they are smaller and the toxins in vaccines might effect them more. Who knows?

My own experience: My ds is 14 months old and he hasn't had a single vaccine. I decided to follow the same course as I did with his sister and delay everything till 6 years of age (and then selectively vax after that). Had he been earlier, I may have been more concerned. Or more sick. Or??? But he was an almost 33 weeker who had very few problems. He's been sick before-he had a bad ear infection and he also had RSV, although it never got very bad (and I actually was going to get that vax or whatever its called, but he was over the gestational age for my insurance company to pay for it). Beyond that he's been just as healthy as his sisters.

I would keep in mind though that he's home with me all the time, no daycare, so his contact with other kids is pretty minimal.

Btw-his 4 year old sister isn't vaxed at all, but his older sister is mostly vaxed (delayed till 4) and his brother is vaxed as well (on time) and his older brother has had pertussis twice, lol. I dont have total faith in vaccines working :P

[sbrinton]

I would do synagis for RSV if you qualify for it. That is not really a vaccine anyway.

Other than that, I don't know!! We have more or less done what you did with both our boys who were preemies. I don't think we'll do MMR, or if we do we will split it up over a few years when the kids are at least 2.

I would look at each vaccine and try to decide the risks of the illness vs. the vaccine. For example, it probably makes sense to vaccinate for pertussis, as this is a lower risk vaccine and a common illness that affects lungs, where preemies are more vulnerable. Rotavirus is another one to start on time, if you do it at all.

I would delay whatever is not really a risk (polio, hep a and b, etc).

I would be even more careful about the number of vaccines at a time (maybe 1 instead of 2 until baby is at least 10 or 12 pounds?).

That's more or less what we did, although our youngest preemie just "caught up" with his third dose of prevnar and had a TERRIBLE reaction. He's very sick from the vaccine. So I don't know if we'll ever do that one again.

[DocsNemesis]

Oh no! What happened? (just curious) I hope he gets better soon!

And I agree, if you do the vaccines, do the ones that are most likely to effect a preemie if they did catch it. Polio is pretty much gone in the US (I dont think theres been a single case in the last few years), tetanus is pretty much a non-worry at this point, etc. You can always get those vaccines done when he is older and healthier.

[sparklett]

We delayed about two months and then did the first two rounds as if DS were full-term. Baaaad idea. Two days after the second round of DtaP (DS was 6 mos.), he started seizuring and they kept occurring on and off for about 6 months. Long story short, both the pediatric neurologist and our pediatrician believe it happened due to an immature immune/neurologic system. Since then (DS is now 2 1/2) we done titer tests only to measure his level of immunity. No vax. We also don't do daycare and are very selective about playgroups and being around sick kids. After a final evaluation by the neurologist, he will re-start his vaccination schedule in a couple of months and we will be using the Dr. Sears schedule.

And definitely do Synagis, if you can. It's not a vaccine.

[mara22]

My DD was also born at 35 weeks, no medical issues though. We have delayed vac's, I have a good ped. who, when I asked about delaying vac's said "oh we won't do anything until 4 months". My dr. believes in only 2 vac's per visit and she determines what to vax when by the season. At 4 months she got DTaP and Pheunoncocal (sp?) and at 6 months (today actually) she got HIB and polio. At 9 months she will get Hep. A and B because we are traveling down south and Dr. thinks it is important to have those.
Good luck with everything.

[Bokonon]

We fully vaxed DS on schedule. He was a 32-weeker. I really wish we hadn't now that I know more about vaccines, but especially because after his 6 month shots, his gross motor development became significantly delayed. He had been developing normally and hitting milestones on time and even early until that point, and while he didn't regress, he didn't sit up unassisted until 8 months adjusted. We started PT at 11 months, and he still didn't walk until he was a week shy of his 2nd birthday!

He didn't have a noticeable reaction to the shots, but I still wonder if that's why he was/is so delayed (BTW, his speech has always been fine, and fine motor skills are good).

DD is a 34-weeker, and we got her 2 month shots as scheduled, but then I got some sense and started researching vaccines. She won't be vaxed again until further notice...I'm hoping until after 2 years unless DH has a strong opinion and can really sell me, which I don't think he will.

I'm a SAHM and she is exclusively breastfed, so she is at low risk for many of the VPDs anyway. I do worry that DS will bring home illnesses from preschool, but I feel she is very protected by being breastfed.

[annekh23]

My DD was officially born at precisely 37 weeks, but I didn't have an early scan and am fairly sure she was closer to 36 weeks, she was in the NICU for 3 days and had horrendous breastfeeding issues, I Eped for 2 months.

I initally said to our doctor that I wanted to wait to vaccinate until she was 2 months after her due date, then unintentionally scheduled the wrong type of appointment and didn't end up getting her first lot of vaccines until her 4month visit, I also didn't want to give her the fully whammy of the US vaccine schedule, our other kids were born in the UK where the schedule is lighter. I went with Hib, Pneumoccal and DTaP for that month, then did a nurse visit at 5mths for polio, spoke to the doctor yesterday for another reason and she asked me about getting her caught up and I explained that I didn't want to bring them any closer together, so I'd catch her up after 6mths rather than doing them more frequently and she was fine with that.

I think weight is also significant, my son was IUGR and was about 9lb when he got his first vaccines and he seemed to react, whereas my other daughter was more like 12lb and was fine, though my DD was a good size, 7lb4oz at birth, she lost alot and gained slowly, so I wanted her to be heading towards 12lb before she got any shots.

She was born in May, so I may have done differently had it been school time, as it was she got her first shots before school began and I kept her away from other children.

[sanguine_speed]

My 34-weeker did not get vaccines.
I decided we needed to work out his challenges over a few years to see where he stood in terms of medical issues before introducing neurotoxins and messing with his immune system.

I am SO glad we waited. It turned out that he began displaying some signs of neurological damage such as speech and development delays, and also developed epilepsy just before age 2. I am so glad that I know these were not caused by vaccines.

He is having an MRI in December, and we will probably choose not to vaccinate in the future no matter the outcome of the MRI.

[justmama]

My two youngest were 34weeks and 33weeks and the 34weeker was given a few vaccines around 18months of age and we stopped at 2 years, nothing since and she's almost 5. My 33weeker had one synagis and nothing else and she's 21 months. I've been soooooo back and forth on vaccines for the last 8 years or so and I just don't know. I start getting really panicky about germs and sickness in September each year and really question my no-vax standpoint and then once the warmer weather hits in April and May and the flu disappears I start to calm down. I am not sold on vaxing or non-vaxing fully at this point but I personally would not vaccinate a preemie on schedule. I would give them a little time to gain some weight and have their nervous system catch up before I injected them with questionable material and disease. Give their little bodies a chance to be healthy enough to recover from vaccines. I will say though that my preemies have lots of trouble in the winter and the 21 month old has already needed her inhaler with the most recent "cold." I am starting my typical freak-out time because of that and because she's prone to super high fevers with her colds(ie, like the one before this one was 104.7 at it's highest). And she has two big sisters in school settings that bring home germs to her. She's still nursing so I have to believe in my heart that that has kept her healthier than she would have been otherwise but still. . . . . there's nothing normal or routine about 104.7 fevers.

[FiveLittleMonkeys]

My 33 weeker hasn't received anything but Synagis. We will re-evaluate when he is older, but our other children have experienced serious vaccine reactions, so he will probably remain unvaccinated. The older kids are in school, but we are very diligent about hand washing and staying away from the baby if we aren't feeling well. He is EBF and doesn't go to day care, so they likelihood of him coming into contact with a VPD is pretty slim, except from his brother and sisters.

It has always seemed weird to me that for everything else, they preach "gestational age," but for vaccines they don't. We had to be VERY firm with one of the neonatologists about them.

[sprouthead]

If you opt to vaccinate, I would *definitely* read each package insert from the vaccines you would use to find out what it says about adjusting for preemies. Some say to adjust by age or weight, some say to give it by chronological age. I've *never* met a pediatrician who has been aware of this. (and we move around alot and ds has had a couple pediatricians now)

I would also read what Dr. Sears has to say about preemies and aluminum in the Vaccine Book. We decided to forego any vaccines containing aluminum after reading that, and then we decided to stop altogether because the remaining vaccines were for diseases we were less concerned about.

good luck!

[Amys1st]

We did the RSV shots and I highly recommend.

We delay and usually my girls are caught up by kindy- at least dd1 was and dd2 will be.

When dd2 Maggie was getting the RSV shots, I kept the vaxes pretty spread out. For dd1, she needed certain vaxes for starting school so when we went in for the RSV shots, she would get a vax her and there at age 5 1/2. My ped came up with the idea and she agrees on delaying as well. When we did Maggie's physical last summer, she may have had a vax. She should be caught up in time for kindy in a few years.

[mama2soren]

My 31 weeker (now 18 months old) has not had any vaccinations. We did do Synagis, which isn't really a vax anyway. I highly recommend Synagis, if you can get your insurance to pay for it.

Honestly, there were a few times that I worried about his tiny lungs. What if he got whooping cough, I thought? But, he was exclusively breastfed, not in day care, and we were proactive about making sure those who spent time with him were healthy (though, we'd have done that even if he was vaxed!). I felt that his risk for becoming ill was as low as it could be.

It boiled down to this for us; that he was so tiny, that I strongly believed that he would be at a higher risk for having an adverse reaction to the vaxes. I mean, he was barely 7 pounds at 2 months! I am glad I made the decision that I did. Learn as much as you can and feel confident about your decision, even if it's different that everyone else's!

[AllyRae]

DD2 was born at 36w0d and had respiratory distress syndrome at birth. We gave her one vax at 2 months old and one vax at 3 months old (HIB and Polio were the two vaxes) and she had horrible reactions to both of them. She hasn't been vaxed since (she's 10 months old next week). She has a lot of sensitivities to vaccines, latex, foods...I'm not sure if it's because she was born a bit early, or what...

[ComplexOphelia]

When we were in the NICU, I talked to our amazing neonatologist about this very thing. With his help, we decided to do Synagis for the first year, as well as give DS HiB, Pc, and DTaP vaccines. Those were the diseases that he said would be most likely to put us back in the hospital if DS endd up with them. I figure that prematurity is his speciality, and if there were any information out there about delaying vax due to size, he would have shared it with me - he's that kind of doctor. He was very supportive of my decision to delay Hep A/B, Polio, etc. We skipped Rotavirus altogether, since DS is at home with me, and very unlikely to be exposed to it.

I feel very confident about our decision. I think it was probably more proactive than we'd have been, had DS not been premature, but sticking to our belief that babies don't need six shots at once. Now, I just need to get our neonatologist to be my pediatrician - she's the one who harasses me about delaying those vaxes "because DS was a preemie." Grrr. Grrrrrrrr.

It depends so much on your situation, since babies are so individual in their NICU stories. What's helped me is to do lots of research on vaxes, and to have my decision made before I go to my unsupportive pediatrician and she tries to scare me into vax-ing.