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Immunisation practices in infants born prematurely: Neonatologists' survey and clinical audit

Authors

  • Nigel W Crawford,

    Corresponding author
    1. National Health and Medical Research Council (NHMRC) Centre for Clinical Research Excellence in Child and Adolescent Immunisation, Murdoch Children's Research Institute, Immunisation Service, Department of General Medicine, Royal Children's Hospital (RCH), Department of Paediatrics, University of Melbourne,
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  • Vivien Yeo,

    1. National Health and Medical Research Council (NHMRC) Centre for Clinical Research Excellence in Child and Adolescent Immunisation, Murdoch Children's Research Institute, Immunisation Service, Department of General Medicine, Royal Children's Hospital (RCH), Department of Paediatrics, University of Melbourne,
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  • Rod W Hunt,

    1. Neonatal Unit,
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  • Charles Barfield,

    1. Neonatal Unit, Mercy Hospital for Women, Heidelberg, Melbourne, Victoria, Australia
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  • Ben Gelbart,

    1. Neonatal Unit, Mercy Hospital for Women, Heidelberg, Melbourne, Victoria, Australia
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  • Jim P Buttery

    1. National Health and Medical Research Council (NHMRC) Centre for Clinical Research Excellence in Child and Adolescent Immunisation, Murdoch Children's Research Institute, Immunisation Service, Department of General Medicine, Royal Children's Hospital (RCH), Department of Paediatrics, University of Melbourne,
    2. Department of Infectious Diseases, RCH and
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Dr Nigel W Crawford, NHMRC CCRE in Childhood and Adolescent Immunisation, Department of General Medicine, 5th Floor, AP1 Building, Murdoch Children's Research Institute, Royal Children's Hospital, Flemington Road, Parkville Vic. 3052, Australia. Fax: +61 3 9345 4163; email: nigel.crawford@rch.org.au

Abstract

Aim:  To determine Australian neonatologists' recommendations for the immunisation of ex-preterm infants and compare their actual immunisation status with recommended Australian guidelines.

Methods:  A self-administered nine-part questionnaire of current immunisation practices was sent to all Neonatologists in Australia (2006). A complementary retrospective immunisation audit was conducted in two tertiary neonatal units in Melbourne. Hospital records and the Australian Childhood Immunisation Register (ACIR) were reviewed; consenting parents were interviewed and primary care physicians' vaccination records were requested. A random sample of preterm infants born between July 2003 and June 2005 at <32 weeks' gestation were selected.

Results:  (i) Neonatologists Survey: The response rate was 68% and the majority of neonatologists (89%) were aware of the current guidelines, but adherence to them varied from 43% to 79%. One-fifth of neonatologists personally do not receive annual influenza vaccination; and (ii) Immunisation Audit: Conducted between October 2006-May 2007 it included: 100 hospital records; 97 ACIR records; 47 parent interviews and 43 primary care vaccination records. Overall vaccination coverage was 90% at 12 months of age. Only 20% (10/50) of infants with chronic lung disease received an influenza vaccination. Vaccines were delayed by greater than one month in 15% of participants for the 2 month DTPa vaccine and 43% at 6 months.

Conclusions:  The neonatologists survey highlighted variable adherence with immunisation guidelines. The audit confirmed preterm infants are frequently experiencing delayed vaccination and recommended additional vaccinations are often not being received. Formulation of strategies to ensure complete and timely immunisation are required, including better utilisation of the ACIR.

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