The American Academy of Pediatrics (AAP) and the United States Public Health Service have recommended immunization of all infants with hepatitis B vaccine.1,2 Although several immunization schedules have been shown to be effective in infants and children, the AAP recommends that the first dose be administered to newborns before they leave the hospital. Alternative schedules beginning between birth and 2 months of age also are acceptable and have been adopted in many practices. These recommendations were based on studies performed in numerous populations demonstrating high immunogenicity when the vaccines were administered in accordance with the manufacturers' approved doses and schedules.
In the previous AAP recommendations, similar latitude was given in the initiation of vaccine schedules for premature infants born to women who were hepatitis B surface antigen (HBsAg)-negative. For premature infants and other infants with illnesses in the first few days of life, pediatricians were advised that administration of hepatitis B vaccine could be delayed until hospital discharge, although it was implied that premature infants should receive hepatitis B vaccine at the same chronologic age as recommended for term infants.3
HEPATITIS B VACCINE IN PREMATURE INFANTS
Studies have revealed, however, that the percentage of infants that develop protective levels (≥10 mIU/mL) of antibody to HBsAg (anti-HBs) and the final anti-HBs concentrations may be lower in premature infants given the recombinant hepatitis B vaccines beginning at birth than if the initial dose is delayed until they are older or weigh more than 2000 g.4-6 In one study,4 the response rate for premature infants who received their first dose of Engerix-B vaccine at a weight of either 1000 to 1999 g or 2000 g or more was 79% and 91 %, respectively; the response rate was 100% for normal term infants.
- Copyright © 1994 by the American Academy of Pediatrics