Children's Hospital Colorado

Vaccines for Babies with Medical Conditions

Physician doing check up on young child

Parents of babies in the Neonatal Intensive Care Unit (NICU) or with medical conditions have a lot to consider when it comes to their baby’s care. Their lives and treatment are just not as simple as many babies’. That’s true when it comes to infant vaccines, but the core truth about immunizations doesn’t change for these babies.

“We know that vaccines are critically important for all babies,” says Theresa Grover, MD, Medical Director of our NICU on Anschutz Medical Campus. “There is strong evidence that they prevent routine illness and life-threatening illness, and that is no different for premature babies.”

Why are vaccines for infants with medical conditions so important?

Vaccines are important for all children. They’re safe and heavily researched, and they save lives. If your baby was born preterm or has an underlying medical condition, vaccines are even more important.

“Babies that are born prematurely are at higher risk of contracting diseases that are preventable by vaccines,” says Dr. Grover. “Their immune systems are less robust, and they are more likely to contract serious illnesses.”

Some vaccine-preventable diseases can even become life-threatening. Babies born prematurely respond well to immunizations, just like full-term babies. Dr. Grover says babies born in the NICU should get their full recommended vaccines at 2, 4, 6 and 12 months old. These vaccinations may take place in the NICU or during their first-year doctor visits. Vaccines are most effective when they’re given on time, so sticking to the recommended schedule is very important.

“Up to half of premature babies are under-vaccinated up to a year and a half after birth,” says Dr. Grover. “Sometimes it’s because the baby was severely ill in the hospital, so they didn’t get their vaccines on time. For those babies it’s important to work with their primary care doctor to make sure they get caught up on their vaccines.”

Flu vaccines for babies and caregivers

Influenza (the flu) can be very serious for premature babies and cause hospitalization. Like all vaccines, the flu vaccine is incredibly important for premature babies. But it’s not the baby who needs to get a shot, at least not immediately. Since babies with medical conditions often have weaker immune systems, it’s very important that their parents, caregivers and anyone else around them get a flu shot every year to protect them from the flu.

It's also important for parents and caregivers to take other steps to prevent the spread of the flu, such as washing hands often and avoiding contact with people who are sick.

Babies can’t get the flu vaccine until they are 6 months old, but it's very important for babies with medical conditions (and all babies) to get the flu shot at that time.

What you should know about the respiratory syncytial virus (RSV)

Respiratory syncytial virus (RSV) is a common respiratory virus and often leads to re-hospitalization for babies who have been in the NICU. Most babies are not eligible for palivizumab, an antibody used to treat RSV. However, some babies in the NICU are, such as those born very prematurely or with heart or lung conditions that require oxygen. The risk of them getting RSV is so great that they are eligible for this antibody, which is very effective at reducing the risk for RSV.

Talk to your care team to see if your baby is eligible for palivizumab. If they are, your baby will take it monthly starting in the NICU and continue it once they leave.

Special vaccine considerations for babies in the NICU

Most babies in the NICU should get their full course of vaccinations. But there are a couple considerations for specific vaccines.

Rotavirus vaccine in babies

Rotavirus is the leading cause of severe diarrhea in young kids, and the rotavirus vaccine is effective in preventing diarrhea. But the vaccine is not suitable for babies with severe intestinal conditions. Your care team should tell you about this if your baby can’t receive the vaccine, and you can also ask them any questions you have about rotavirus vaccine and your child.

Hepatitis B vaccine in babies

Normally, babies get a hepatitis B vaccine within the first 12 hours after birth. However, pre-term babies with low birth weight (under 2 kilograms) whose moms test negative for hepatitis B can instead receive their hepatitis B vaccine when they’re one month old or upon hospital discharge. Pre-term babies whose moms have a positive or unknown hepatitis B infection should receive a dose of the hepatitis B vaccine at birth regardless of birth weight to prevent infection.

If you have any questions about infant vaccines while you’re in the NICU, ask your care team or ask to talk to the NICU’s pharmacist.

Our best advice? Talk to your doctor about vaccines.

Depending on their underlying medical conditions, there may be some differences between the standard vaccine schedule and what’s recommended for your child. Your child’s health and safety are of utmost importance to their pediatrician. If you have any questions about vaccines or the schedule, please speak with your child’s doctor. They can make a recommendation based on the best-available guidance that keeps your child protected – and thriving.

To learn more about how vaccines protect children and communities from preventable illness, please visit Immunize Colorado.

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