Immunization Case Study

Chamberlain College of Nursing NR602: Primary Care of the Childbearing and Childrearing Family November 2020

Case #1: Newborn Nursery Immunization

Scenario: You are rotating in the newborn nursery. Your next admission is a term newborn born at 3.5 kg, with all maternal labs negative. The infant’s physical examination is normal, and there are no immediate health concerns.

1. What vaccine(s) should the newborn receive and why?

The newborn should receive the Hepatitis B vaccine within the first 24 hours of life. The Hepatitis B vaccine is the first immunization recommended for all newborns, regardless of the mother’s Hepatitis B status. Administering this vaccine shortly after birth serves several critical purposes:

• Prevention of Perinatal Transmission: Hepatitis B can be transmitted from mother to child during childbirth. Even if the mother’s Hepatitis B surface antigen (HBsAg) test is negative, there is a small but significant risk that maternal status could change or be inaccurately recorded. By vaccinating the newborn within the first 24 hours, healthcare providers can ensure early protection against the virus.
• Protection Against Chronic Infection: Infants infected with Hepatitis B have a high likelihood of developing chronic Hepatitis B, which can lead to severe liver diseases such as cirrhosis or liver cancer later in life. Early vaccination dramatically reduces this risk.
• Foundation for Immunization Schedule: The Hepatitis B vaccine is the first dose in a series that will be completed over the first six months of life. Administering the vaccine at birth helps establish the routine immunization schedule, ensuring timely protection against other infectious diseases.

2. What would you do if the mother tested positive for Hepatitis B?

If the mother tested positive for Hepatitis B surface antigen (HBsAg), the newborn would require immediate intervention to prevent the transmission of the virus:

• Administer Hepatitis B Vaccine: The vaccine should be given within the first 12 hours of birth. This will stimulate the infant’s immune system to produce antibodies against the Hepatitis B virus.
• Administer Hepatitis B Immune Globulin (HBIG): HBIG provides passive immunity by supplying antibodies that offer immediate, short-term protection against the Hepatitis B virus. This is critical because it helps protect the infant while their immune system is still developing a response to the vaccine.
• Follow-Up Care: The infant should complete the Hepatitis B vaccine series as recommended, typically at 1-2 months and again at 6 months of age. Additionally, the infant should be tested for HBsAg and Hepatitis B surface antibody (anti-HBs) at 9-12 months of age to ensure that the vaccination was successful and the infant is not infected.

This dual approach of providing both the vaccine and HBIG within 12 hours of birth is highly effective, reducing the risk of mother-to-child transmission of Hepatitis B by over 90%.

3. What would you do if the mother’s Hepatitis B status was unknown?

If the mother’s Hepatitis B status is unknown at the time of delivery, the following steps should be taken to protect the newborn:

• Administer the Hepatitis B Vaccine: The vaccine should be given within 12 hours of birth, as early vaccination is crucial in preventing possible transmission.
• Administer Hepatitis B Immune Globulin (HBIG): If the mother’s Hepatitis B status cannot be confirmed within 12 hours, HBIG should also be administered to the newborn as a precaution. This ensures that the infant is protected against potential exposure to the virus.
• Maternal Testing: The mother should undergo immediate testing for HBsAg. If the test comes back positive, it confirms the need for the newborn to receive both the vaccine and HBIG. If the test results are negative, the newborn will continue with the standard Hepatitis B vaccine schedule.
• Follow-Up: The infant should continue with the complete Hepatitis B vaccine series. Testing at 9-12 months will ensure that the infant is adequately protected and not infected with Hepatitis B.

Taking these steps ensures that the newborn is protected even in the absence of complete maternal information. Early intervention and adherence to the immunization schedule are key to preventing chronic Hepatitis B infection and its long-term complications.

This comprehensive immunization strategy highlights the importance of early protection against Hepatitis B, taking into account various maternal scenarios. By ensuring timely administration of vaccines and immune globulin, healthcare providers can significantly reduce the risk of Hepatitis B transmission and promote long-term health for the newborn.