UNIVERSITY HOSPITALS OF COVENTRY & WARWICKSHIRE NHS TRUST
NEONATAL UNIT – WALSGRAVE HOSPITAL
GUIDELINES FOR PRIMARY IMMUNISATION
IN PRETERM INFANTS
1. Informed/signed consent must be sought prior to immunisation. Parents must be given
information leaflet regarding immunisation.
2. Infants should receive combined DTP and HiB vaccines at 2, 3 and 4 months
chronological age.
Meningococcal Gp C Conjugate vaccine should be administered at 2, 3 and 4 months
chronological age.
Oral Polio vaccine should be administered on discharge of the infant from hospital and
then two (2) further doses at 1 and 2 months thereafter.
3. 0.5 ml of combined DTP/HiB should be administered by deep IM injection to the
anterolateral aspect of the thigh or upper arm using a 23 or 23G needle.
4. 0.5 ml of Meningococcal Gp C Conjugate vaccine is given via the IM injection at a
different site to the DTP/HiB vaccine.
5. The identity of the vaccine must be checked to ensure the right product is used in the
appropriate way on every occasion.
6. The expiry date must be noted. Vaccines should not be used after the expiry date on the
label.
7. The date of immunisation, title of vaccine and batch number must be recorded on the
recipient’s record. When two vaccines are given simultaneously, the relevant sites should
be recorded to allow any reactions to be related to the causative agent.
8. The recommended storage conditions must have been observed. Freeze-dried vaccines
must be reconstituted with the diluent supplied and used within the recommended period
after reconstitution.
9. Before injection, the colour of the product must be checked with that stated by the
manufacturer in the package insert. The diluent should be added slowly to avoid frothing.
A sterile 1 cm syringe with a 21 G needle should be used for reconstituting the vaccine
and a smaller gauge needed (23 G or 25 G) for injection, unless only one needle is
supplied with a pre-filled syringe DTP/HiB.
10. When the skin is cleaned, alcohol or other disinfective agents must be allowed to
evaporate before injection of vaccine since they can inactivate live vaccine preparations.
CONTRAINDICATIONS
1. Premature infants with an acute severe infection.
2. Premature infants who have a definite history of severe local or general reaction to
preceding dose.
Local – An extensive area of redness and swelling which becomes indurated and involves
most of the anterolateral surface of the thigh or a major part of the upper arm.
General – Anaphylaxis, bronchospasm, laryngeal oedema. Encephalopathy of unknown
aetiology occurring within seven days following previous vaccination with pertussis
containing vaccine. In these circumstances, the vaccination course should be continued
with diphtheria, tetanus and HiB vaccines.
3. Immunodeficiency: Live vaccines OPV, BCG should not be given to infants with
immunodeficient states (HIV, severe combined immunodeficiency Di George Syndrome
etc.) Immunisations should not be given to infants who were on steroids for less than one
week prior to immunisation. (Please discuss with Consultant).
4. Parental refusal.
5. OPV should not be given while the infant is on the ward but should be given on
discharge.
SPECIAL WARNINGS AND PRECAUTIONS
1. Temperature of > 40.5C within 48 hours of vaccination, not due to another identifiable
cause.
2. Collapse or shock-like state (hypotonic-hyporesponsive episode) within 48 hours of
vaccination.
3. Convulsions with or without fever occurring within three days of vaccination.
4. Very preterm infants especially those with chronic lung disease or prolonged ventilatory
support should be monitored (cardio-respiratory) 24-48 hours after immunisations for
apnoeas.
02/01
Review Date 02/03