Ref Number = ASPR0029
Immunization in special condition: preterm infants
Hartono Gunardi
Department of Child Health dr.Cipto Mangunkusumo Tertiary General  Hospital - Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
Email: hartono@ikafkui.net
Indonesia was the fifth country with highest number of preterm infants after India, China, Nigeria and Pakistan; and the ninth country of most prevalence preterm birth 15.5 per 100 live birth in 2012. 
Immunization is often delayed in preterm infants due to medical problems. On the other hand, preterm infants are prone to infectious diseases due to immature immune system and have lower maternal antibody compared to term infants. Therefore, the preterm infants should be protected by immunization. Stable preterm infants who do not have serious infection, metabolic, renal, cardio-respiratory or neurologgic problem and show  improvement and steady weight gain can be immunized, 

Studies shown evidences that preterm infants could produce sufficient antibody to vaccines compared to term infants with equivalent chronological age, not corrected age, except for hepatitis B vaccine which is influenced by low birth weight. Preterm infants with birth weight less than 2000 g born from HBsAg-negative mother, hepatitis B immunization could be postponed until body weight reached 2000 g or until 1 month of age. Preterm infants born to HBsAg-positive mother, should have hepatitis B vaccine and hepatitis B immuneglobuline within 12 hours at separate extremities.  
Preterm infants can tolerate most of immunization as term infants. Nevertheles extremely low birth weight infants may suffer adverse event following immunization such as apneu attack with/without bradicardia was reported following diphtheria, tetanus and whole-cell pertussis vaccine. Risk factors include apneu during 24 hours before immunization, younger gestational age, body weight less than 2000 g during immunization which becomes indication to monitor infants until 48 hours after immunization.
Keywords: preterm; infants; immunization; adverse events following immunzation
1. Blencowe, H., Cousens, S., Oestergaard, M.Z., Chou, D., Moller, A.B., Narwal, R., et al. 'National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications', Lancet, 2012: 379; 2162-72.
2. American Academy of Pediatrics. 'Immunization in preterm and low birth weight infants' in Kimberlin DW, B.M., Jakson, M.A., Long, S.S editors Red Book 2015 Report of  the Committee on Infectious Diseases. Eds-30. Elk Grove Village, IL: American Academy of  Pediatrics; 2015 p. 68-70.
3. American Academy of Pediatrics. 'Hepatitis B vaccine' in Kimberlin DW, B.M., Jakson, M.A., Long, S.S editors. Red Book 2015 Report of the Committee on Infectious Diseases. Edisi ke-30. Elk Grove Village, IL: American Academy of  Pediatrics.2015 p. 406-18.
Disclaimer: The Views and opinions expressed in the articles are of the authors and not of the journal.
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