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Immunisation - an overview for Newborn Services

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Preterm and low birthweight infants

Vaccination as per schedule (i.e., at the usual chronological age, with the usual vaccine dose and interval) is recommended for preterm infants and infants with low birthweight. If an infant is in hospital when vaccination is due, the scheduled 6-week vaccines, should be given at the appropriate chronological age.

Rotavirus vaccine

Rotavirus vaccine, Rotarix, is given at 6 weeks and 3 months of age. Any infant in NICU, who is eligible for their 6 week vaccinations and who can tolerate the oral volume and for whom it is not contraindicated should receive the Rotavirus the vaccine.

For catch up schedule, the first dose should be given before 15 weeks (latest is 14 weeks and 6 days) and the second dose should be given before 25 weeks (latest 24 weeks and 6 days)1. For more information see Immunisation - Rotavirus

Routine Schedule for all

Age Vaccine Dose Site
6 Weeks Infanrix-hexa
Prevenar 13

Left Vastis lateralis
Right Vastis lateralis
3 Months Infanrix-hexa
Prevenar 13
Left Vastis lateralis
Right Vastis lateralis
5 Months  Infanrix-hexa
Prevenar 13
Left Vastis lateralis
Right Vastis lateralis

NB. Infanrix-hexa contains diphtheria, tetanus, acellular pertussis, inactivated polio, hepatitis B and Haemophilius influenzae type b

See Immunisation Handbook 2017 for more information

Precautions, Contraindications and Adverse Effects


Serious reaction following a previous dose of vaccine, namely:

  • Encephalopathy within seven days 
  • Immediate severe anaphylactic reaction to the vaccine. 
  • Presence of an evolving neurological disorder until stabilised. 


  • Reaction following previous dose (not shown to be associated with long term sequelae) 
  • Temperature of >40.5°C within 48 hours not due to another identifiable cause. 
  • Persistent inconsolable crying lasting >3 hours. 
  • Convulsions with or without fever occurring within 3 days of vaccination. A family history of convulsive fits do not constitute contraindications. 
  • Collapse or shock-like state (hypotonic, hyporesponsive episode - HHE) within 48 hours. 
  • Administer with caution to babies with thrombocytopenia. 
  • Consider delaying vaccine if baby on steroids as may have reduced immunogenicity (discuss with consultant). 

Possible adverse effects of Immunisations

The Nurse will ensure the following effects are observed and reported to Charge Nurse, Registrar/NS-ANP and appropriate management instituted.

  1. Localised reaction. Redness or swelling.
  2. Feed intolerance, (e.g. vomiting).
  3. 'Grizzliness'.
  4. Febrile (core temp of 37.5°C or greater). Stat dose of Paracetamol liquid may be prescribed.

Preparing and giving vaccines

Registered Nurses who are required to administer Hepatitis B and Hep B Immunoglobulin after birth and designated Registered Nurse who has completed the Vaccination Programme Training and Checking Registered Nurse follow the steps below to ensure vaccine is given correctly and that vaccine is only out of fridge for the shortest possible time before administration.

  1. Check with baby's nurse that baby is well and it is appropriate to administer vaccine at that time. 
  2. Both nurses check consent for vaccine has been signed by parent.

    Hepatitis B Surface Antigen Positive or Status Unknown Mother
    - On the National Hepatitis B Immunisation Programme Form (HE1446) 
    - Also parent has signed for the Hep B Immunoglobulin consent on the above form. (There is no need for parent to sign the medication chart if HE1446 form has been signed.) 
  3. Check Dr/NS-ANP has prescribed the immunisations on medication chart stat drugs page. 
  4. For all babies receiving Infanrix-hexa, Prevenar 13 Vaccinations and Rota Teq, parent to countersign on the medication chart stat drugs page and to print surname under signature.
  5. Collect baby's Multidisciplinary Notes, Medication Chart, Well Child Health Book, NIR3 form, appropriate syringe(s) and needles.
  6. Nurse checks the fridge temperature recording sheet, beside the vaccination fridge, for previous 5 days. Check that the recorded temperature range is within +2° to +8° C (ideally +4° to +5°C). Removes the vaccines to be used (NOT THE CONTAINER).
  7. Perform 2 nurse checking procedure.
  8. Infanrix-hexa must be reconstituted prior to use as follows:
    - Attach needle to prefilled syringe.
    - Transfer the syringe's liquid suspension to the vial containing the Hib pellet.
    - Do not swab the top of the vial with an alcohol wipe
    - Shake the vial well to ensure the Hib pellet is completely dissolved.
    - Draw the reconstituted vaccine back into the syringe.
    - Attach the appropriate sized needle to the syringe for vaccine administration. Do not prime needle.
    - After reconstitution the vaccine should be injected promptly.
  9. All vaccinations are SINGLE USE ONLY.
  10. Use suitable needle. Size depends on baby's current weight. Babies < 2500 grams 25 gauge needle and babies >2500 grams 23-25 gauge needle. DO NOT PRIME NEEDLE.
  11. Checking nurse positions baby on appropriate side and holds baby's leg with knee bent and calf of leg touching back of thigh.
  12. Do not swab skin prior to vaccination.
  13. See below for details on injection site.
    - Administering nurse then injects vaccine into muscle at a 90° angle. Do not draw back on syringe.
    - Administer Infanrix-hexa in to the left Vastus Lateralis followed by Prevenar 13 in to the right Vastus lateralis.
    - When vaccine has been injected, leave needle there for further 5 seconds to allow for dispersal of vaccine.
       Smoothly withdraw needle. There should be no ooze of vaccine.
    - If blood spot, dab with cotton wool. Do not rub vaccination site. Observe for further 30 seconds.
    - Then baby may be turned and further vaccine given.
  14. Console baby. Then complete documentation.
  15. Baby must be nursed on apnoea mattress for 24 hours after vaccine given.
  16. Documentation:
    7 places (or 9 places if Mum Hep B surface antigen positive or status unknown). Record batch no, dose, expiry date, which leg, date, and signature.
    - For babies of Hep B positive or unknown mothers HE1446 form to be completed
    - Well Child Health Book (last page in book is the immunisation record)
          Infanrix-hexa: remove the square sticker from the Hib vial and place in Well Child Book. (Sticker states batch number and expiry date.)
          Place the second sticker from the Hib vial on the drug chart
          Prevenar 13: record batch number & expiry date in space provided
    - Baby's medication sheet
    - Multidisciplinary notes
    - NIR3 form filled in and placed in immunisation folder for posting
    - Baby's Feeding/observation Sheet
    - Baby's Care Map
    - NWH NICU computer database

Site for administering immunisations to babies in Newborn Service

IM siteIntramuscular (IM) injection site

Thigh (Vastus Lateralis) is the recommended injection site for the IM immunisations.

Vastus Lateralis Muscle

The vastus lateralis is a thick, well developed muscle located on the anterolateral aspect of the thigh. The injection site is above the junction between the middle and upper third so that vaccine is deposited at the junction. The needle should be angled at a 90° angle. (More superficial injections of toxoid vaccines result in greater rates of local reaction than deeper ones), depending on the size of the baby.

NB: The buttocks are not used because of poor vaccine uptake in fat, possible increased risk of abscess formation and possible risk of sciatic nerve involvement.

Prevenar® and Infanrix®-hexa are intra muscular injections

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Document Control

  • Date last published: 04 October 2018
  • Document type: Clinical Guideline
  • Services responsible: Neonatology
  • Owner: Newborn Services Clinical Practice Committee
  • Editor: Sarah Bellhouse
  • Review frequency: 2 years