The night before our real “due date”: 39 weeks and 6 days : The Schedule

Tonight I am not sleeping .. it’s not just because we are excited about the first day of school for Mia and Juliet. Tomorrow morning Jules goes to school for the first time and Mia has her first real day .. I am thrilled for them and cant help but tear up thinking of how big they are getting. But it’s not just excitement keeping me awake… I’m also scared. I’m scared because Peter and Maurice had to start their vaccines and had his first round of shots.

There is no question that preterm infants are at a higher risk of death and sickness from vaccine preventable diseases. As a practitioner I know this and can understand the importance. The current guidelines recommend to vaccinate according to chronological age, regardless of current weight or birth weight. They do not take into account gestational age. What this means is that although the boys were born about 3 months early, weighed 3 pounds combined and technically should not even be here yet.. the guidelines say vaccinate them the same way you would a healthy term newborn baby. I am having so much trouble wrapping my head around it. The doctors enforce it and I get it but I’m scared. I’m terrified because premature babies especially those born at a very low birth weight >1000 grams have episodes of apnea after them. Up to 30% of babies have cardiopulmonary events well documented in studies after receiving these immunizations. That means about 3 out of every 10 premature stable babies will have an episode where they stop breathing within 72 hours of getting the vaccines.

The two month schedule recommended for Peter and Maurice and all babies regardless of size or age consists of :

Hepatitis B ( which is usually given at birth and then again at 2 months of age)

DTa P : Diphtheria ( a serious throat infection that can block the airway) , tetanus ( a nerve disease that caused by a toxin producing bacteria contaminating a wound) and acellular pertussis (whooping cough)

Hib : Haemophilus influenzae type B ( this bacteria was the leading cause of meningitis in children under 5 before the vaccine ) the Hib vaccine also protects from pneumonia and pericarditis which is an infection around the heart

IPV: inactivated polio virus ( polio is a viral infection that can cause permanent paralysis)

PCV: Pneumococcal conjugate ( protects against pneumonia, blood infections and bacterial meningitis )

RV: Rotavirus ( a gastrointestinal virus that causes diarrhea and can lead to dehydration)

And just when you think you had it all get ready because at 4 months it’s time to do most of these all over again

There has been a huge effort to keep premature infants on the “schedule” and have their vaccines completed at the same time as a healthy term baby. It is understandable as many of these diseases cause significant illness in premature babies and can even lead to death. They are at a much greater risk, however there issues that arise. These issues are not my opinions but rather ones present in the current studies.

1. The hepatitis B vaccine is recommended at birth and then again at 2 months of age. Many studies are now showing that in premature babies who have low birth weight also have immature immune systems and are not able to mount an appropriate immune response. It is suggested that as long as the mother does not have hep b virus in her blood you can delay it for babies who weigh less than 2000 grams at birth ( 4 lbs 7 oz) Hep B is transmitted through blood , semen or other bodily fluids. It can transmitted by IV drug use. If you are at risk make sure you are tested to ensure you will not pass it to your baby. If your baby is less than 2000 grams you may want to talk to your doctor about delaying the immunization of Hepatitis B until you are out of the NICU. Studies support that choice.

2. Pediatrix is the brand name of a popular vaccine made by GlaxoSmithKline. It is a convenient 5 in one vaccine and seems to be a fan favorite with the NICUs and pediatricians. It consists of DTaP- polio- and Hib: sounds so great ” save your baby the extra stick” we can do them all at once they say.. well this does not seem to be very well studied in babies with very low birth weight or those who are very premature. Surprisingly, this is the only way to vaccinate pertussis in the two NICUs we have been to…In combination with 4 other vaccines all at the same time. We “don’t separate them” and “we usually do all the two month vaccines over 1-2 days” At 2 months Maurice was still having episodes but even still I was told you should do it.. you have to do it .. to “keep the schedule.” It’s ok if they “have an episode” don’t want to eat or get a fever because … it’s “normal.” There is nothing normal about a 4 pound baby becoming apenic or not breathing. According to the latest study “13-30% of medically stable premature infants develop apnea” after .. the GSKs combination vaccine of HIB, polio and DTP. The conclusion is that it has a “clinically accepted safety profile when used in infants with prematurity. It’s nice to know that a rate of up to a 30% of babies that stop breathing after given one dose is clinically accepted. It also continues to say that “additional studies are needed in very premature and very low birth weight infants.” That is what Maurice is or any baby less than 1000 grams and Peter was not too far behind at 1170. You can read more about it in the 2018 study here ->

Straight from GSK safety page on Pediatrix they state that “in clinical trials was associated with higher rates of fever relative to separate administered vaccines” and “apnea following intramuscular injection has been observed in some infants born prematurely.” Again right from the package insert there ” were 5 deaths among 8,088 recipients and 1 death reported among 2,287 recipients in comparator vaccines .. cause of death was 2 cases of SIDS or sudden infant death syndrome, convulsive disorder, sepsis and neuroblastoma. There was one episode of SIDS in comparable vaccine. ” they continue to say that “by chance alone some cases of SIDS can be expected to follow recipient of pertussis – containing vaccines. There is also a nice added bonus “pediatrix has not been evaluated for carcinogenic or mutational potential or for impairment on fertility.” There is more data in the handout comparing the rate of seizure in dtap alone vs pediatrix and it is similar. It’s made with formadehylde and aluminum but have no fear because it also says it’s free of preservatives. Read and enjoy.

The National Vaccine Injury Compensation Program (NVICP) .. yes such a thing exists .. a program dedicated to awarding compensation to people after injury from vaccines .. has awarded many people compensation after the pertussis vaccine. Claims asserted that pertussis vaccine causes 333 seizures and 189 were awarded compensation .. anaphylaxis 7 claims 6 awards.. hypotonic/hypo responsive injuries leading to early death 107 reported and 73 awarded and long term neurological disease 51 claims 18 awards

Pertussis can be very dangerous for babies born prematurely. It is a disease that is still prevalent and presents a real risk. My babies are so small .. their lungs and immune system still not developed. I know I have to immunize them .. I want to protect them in any way I can. .. but I also want keep them safe from the dangerous side effects of these vaccines.. especially given the medical data that clearly states the combination Pediatrix is not yet well studies in premature babies . Right now this is the best I have … this is the only way I can give my baby protection against pertussis. We already passed the 2 month mark so we are on a delayed schedule but I had to wait until Maurice was no longer having episodes. I couldn’t bring myself to start vaccines on a 4 pound baby who would stop breathing at night.

I saw him today.. he looks so much better so much stronger.. we are almost “term.” I know it is safer for him to get these while he is in the hospital .. being monitored closely .. I put off as much as I could but now he is doing a little better and to me the safest option I have to is start his immunizations in the NICU

I did the same for Peter today. I won’t take my eyes off him. The owlette sock is wrapped tight around his ankle. I have lying on my chest. He is having a very bad night ..I’m worried about my Maurice and wish I could be with him but at least he has care if he needs it. It is so much safer for him.

I know people have very strong opinions on vaccinations. When you add to it a baby born three months too soon you have a whole new set of issues. Not only in the safety profile of the available vaccines but also in the efficacy of them.

Talk to your doctor. Base your opinions on facts and not just what you hear celebrities say. Try to find a doctor that will listen to you, respect you and educate you. Respect them as well. Today my doctor said “it’s like a Chinese menu” when you start doing that. “One from a and one from b.” I laughed because it really is.. you start to bargain. Know what vaccines your baby is getting. Know what your options are and what you are comfortable with .. delayed schedule or separating vaccines.. but do it based on facts and consider an order of “importance.”

The NICU nightmare continues but thank god my baby boy is doing better and will hopefully be home soon. He was taking a few bottles and I am hoping the vaccines don’t set him back. He is growing so strong and weighs 5.11lbs and Peter is now 7.9 pounds.

We have so many schedules to stick too and it is so not my strongest skill. I’m happy the girls will be out and socializing .. making new friends and learning new things.. but nervous about this added responsibility of getting to places “on time” when I have one baby home and one baby still in the hospital. I have been blessed with a wonderful support system and incredible family and friends who have all offered so much help.

I’m trying to keep focusing on the now and keep going day by day.. these beautiful faces make it so much easier to do!! Wishing all the babies out there a wonderful new school year and lots of love xoxo and to all the mommies .. packing lunches and doing homework .. the days go by so slow but the years so very fast .. enjoy the craziness and take the time to appreciate your perfect healthy babies.. try to take in these precious moments .. its easy to loose site of what is important when you are running always so fast .. 💖

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