The Question of Preemie Immunization

By Bri Ziganti

As 2015 draws to a close, the new year brings the promise of fresh starts, cold weather, and unfortunately, flu season.  While all babies have weak immune systems, the preemie defense network is especially fragile.  This inspires many questions for parents and caregivers of preemies.  Why are premature babies so vulnerable?  Should vaccinations be a priority for your preemie patient or child?  What natural defenses do babies have at birth?  And why is preemie immunization such an important topic?

Born Vulnerable: Why Preemies Struggle to Avoid Infections

In utero, a growing baby begins producing the T and B cells needed to deter pathogens; however, their immune system’s components will not completely mature until several months after birth.  In order to compensate, mature antibodies from the mother pass through the placental barrier to the developing fetus during the late stages of a normal pregnancy, an advantage which will protect the newborn until he or she is about three months and their own immune system begins to take over.  These immunoglobulins also act as an important safeguard against extreme manifestations of placental infections, conditions which cause severe inflammatory response that can permanently damage a fetus.

Because of their early birth, most preemie children miss out on this bonus infusion of infection-fighting proteins, leaving them even more vulnerable to disease throughout early childhood.  Many parents wishing to prolong this window of bolstered immunity choose to breastfeed their preemie in order to transfer additional antibodies.  However, several independent studies have found that children who were born prematurely are actually twice as likely to develop pneumonia and other flu-related complications regardless of passed immunities, and recommend that vaccines be a part of routine preventative care as the child grows.  Typically, this protection should start as early as possible.

“Premature infants are at increased risk of vaccine preventable infections, but audits have shown that their vaccinations are often delayed. Early protection is desirable,” writes J. Bonhoeffer, author of Immunisation of premature infants.

Although vaccines are an undeniably important part of your baby’s care, successful preemie immunization doesn’t only depend on medicine!  Your child has an amazing array of natural defenses that can be encouraged through thoughtful neonatal care.

Supporting Natural Defenses to Shield Them from Harm

Throughout your baby’s stay in the NICU, neonatologists will be on the lookout for common infant infections.  Pneumonia, meningitis, UTI’s, NEC’s, and blood infections like sepsis are all frequently occurring diseases in the preemie community.  Usually, nurses will perform chest X-rays and blood tests to check for signs of infection development before sending your baby home.  Maintaining a stable body temperature and keeping a proper balance of good bacteria is vital to preventing many of these disorders.  This balance is a delicate progression that begins at birth; as a fetus acquires all its nutritional requirements directly from its mother, their G.I. tract is sterile while in-utero.  Most babies usually pick up their first gut flora on their journey through the birth canal; however, preemies with immature digestive development or full-term babies delivered by C-section receive their bacteria from the immediate surrounding environment.

Unfortunately, this means that the digestive processes of cesarean-born infants take a little longer to acclimate than vaginally-birthed babies, about six months to  a normally-birthed infant’s one.  Happily, all parents can promote healthy gastrointestinal colonization of their children through breastfeeding or supplemented formula and plenty of skin-to-skin contact.  Most pediatricians will recommend combining these beneficial activities by practicing Kangaroo Care during feeding times.

Preventative Medicines and Measures to Better Protect your Preemie

Even after all of this maternal and paternal aid, babies (especially preemie infants) are still at risk from contracting harmful antigens too powerful for them to fight alone.   Pediatricians endorse a meticulous adherence to sanitation, medical checkups, and preemie immunization schedules to increase the odds of a premature child’s survival.  Children recovering from their time in the NICU should be kept in a warm, stress-free atmosphere until they have grown accustomed to life at home.  Do not take your baby on unnecessary outings until he or she has adjusted to their new surroundings and have healed from any treatments or invasive surgeries.  It will be easiest for your child to heal when they feel relaxed and safe.  As such, parents may need to alter their lifestyles during this transitional period; for example, many premature infants are born with underdeveloped lungs and cannot tolerate constant irritants like cigarette smoke.  Once he or she has reached three to six months of age, incorporating immune-boosting solids like zinc into your child’s diet should also help with avoiding sickness and decreasing recuperation times.

During flu season or amidst other respiratory outbreaks, it is imperative that parents be extra-cautious about exposing their baby to a potentially hazardous environment.  Shana Bereche, mom of now-healthy preemie Leighton, found out the hard way that her young daughter was especially vulnerable to the recent upsurge in measles infections when she brought her baby to her routine checkup.  The baby was only briefly exposed to an unvaccinated patient, but was forced to remain under quarantined monitoring by the health department for nearly a month until they could determine that the danger had passed.

“It’s infuriating to protect a preemie baby through utero and after and then know that all she did was go to a doctor’s appointment that she had to go to and she was exposed,” her mother said.

While measles is an undoubtedly more troubling threat than the typical perils of flu and cold season, something as simple as the sniffles can still be deadly.  Parents can somewhat lessen the risk by keeping a healthy home environment, like making sure all caregivers and immediate family members follow a strict handwashing routine, and any sick siblings refrain from playing with the baby until they recover.  Though everyone should be exposed to mild diseases during childhood to build natural antibody defenses, fragile preemies cannot handle too much stimulation.  Vaccines are still one of the best tools to foster safe surroundings for your preemie.

Vaccinating your Baby

According to the CDC, preemie immunizations must begin soon after birth to protect children from common diseases (as simple as a cold) that can take a life-threatening form in infants and toddlers.  Infections such as RSV are highly communicable and manifest in almost every single child by the second birthday.  Since preemies already have an immature immune system, their caretakers need to keep up-to-date on all available vaccines.  Unfortunately, the WHO reports that over 2 million people die each year from diseases preventable by vaccine, simply because the medication wasn’t given or they refused to see a doctor.  About 430 unvaccinated children die every day from measles alone, an otherwise easily avoidable illness.  Parents can plan for each vaccine by following a recommended immunization schedule, which should be provided by your child’s doctor.

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