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Suggest The Immunisation Schedule For An Infant
Question: Dear doctor
I am asking this question for my daughter who delivered in hospital on 17/03/2015. Her pregnacy was an ivf pregnancy. The actual date of delivery was 13/ 04/ 2015 [due date].Her delivery was a cesarian section due to low afi value [ 5.5] in scan report.The babygirl was born slightly preterm [26 days before due date]. After delivery the baby was shown to us and shifted to ? incubator in neonatal care unit for observation. The next day [18/03/2015] the baby was handed over to us again. The next day [19/03/2015] the consulting paediatrician of the hospital said she is having jaundice [liver test value around 12.6]and again the child was shifted to neonatal care unit. The paediatrician also said that the jaundice may be due to o-ve blood group of mother and 0+ve blood group of the child and as a extra care they are shifting her to neonatal care.He also said that the liver test value come down below 9 she can be discharged from the hospital. The next day [20-03-2015] the value came down below 6 and we got discharged. Now the baby is fine and doing well.My question is about immunisation programe and developmental mile stone. Regarding milestone of development which date to follow the actual preterm delivery date of 17/03/205 or the due date of 13/04/2015?. While getting discharged we asked the paediatrician about immunization. He said they did not start the immunization programe at the time of birth due to preterm baby and we can start it later.We came to our place 75 km away from the deliverd hospital. We have started the immunization programe on 30 /03 /2015 [ after telephonic advice from paediatrician] by giving her oral polio vaccine and bcg from a nearby govt hospital [ on this date these two merdicines are given only in govt hospital,other private hospital only has this facility of giving these medicines at a differnt date later than 30 / 03 / 2015], So we choose the nearby govt hospital].I am up loading two documents . The first document is the record given from govt hospital after administrion of oral polio and inj bcg [30/04/2015] That is marked in the first box of the document. In the second box they have marked 45 days and a word starting by letter P[dont know what that word meant]. What ever may be this vaccine is this 45 days mentioned mean 45 days after actual delivery or after giving the first vaccine on 30/04/2015 or 45 days after due date. When i enquired i came to know that ?hepatitis vaccine should be given before 45 days after delivery and after 30 days of the first vaccine[30/4/2015. Is this correct? Now doctor you know the vaccines givesn and dates then i want to know when shall we give the next [second]vacination and what all vaccine to give?As mentioned earlier hepatitis vaccine was not given at the time of birth or the first vaccination date[30-04-2015]. The second document uploaded is a copy of immunisation progarme schdule in XXXXXXX Ther they have mentioned hepatitis vaccine at birth then hepatitis vaccine2 between 6/ 8 weeks etc. In our case we have not taken hepatitis vaccine yet. When is the apt date to take Hepatitis vaccine ,dpt vaccine and opv2 ?. in the second document they have mentioned XXXXXXX govt recomendation , iap recommendation etc . what is this mean.Is it necessary to take thies vaccine for child living in XXXXXXX Kindly go throug the second document and recommend a immunisation schedule[ [date / month/ year] for our baby?
I am asking this question for my daughter who delivered in hospital on 17/03/2015. Her pregnacy was an ivf pregnancy. The actual date of delivery was 13/ 04/ 2015 [due date].Her delivery was a cesarian section due to low afi value [ 5.5] in scan report.The babygirl was born slightly preterm [26 days before due date]. After delivery the baby was shown to us and shifted to ? incubator in neonatal care unit for observation. The next day [18/03/2015] the baby was handed over to us again. The next day [19/03/2015] the consulting paediatrician of the hospital said she is having jaundice [liver test value around 12.6]and again the child was shifted to neonatal care unit. The paediatrician also said that the jaundice may be due to o-ve blood group of mother and 0+ve blood group of the child and as a extra care they are shifting her to neonatal care.He also said that the liver test value come down below 9 she can be discharged from the hospital. The next day [20-03-2015] the value came down below 6 and we got discharged. Now the baby is fine and doing well.My question is about immunisation programe and developmental mile stone. Regarding milestone of development which date to follow the actual preterm delivery date of 17/03/205 or the due date of 13/04/2015?. While getting discharged we asked the paediatrician about immunization. He said they did not start the immunization programe at the time of birth due to preterm baby and we can start it later.We came to our place 75 km away from the deliverd hospital. We have started the immunization programe on 30 /03 /2015 [ after telephonic advice from paediatrician] by giving her oral polio vaccine and bcg from a nearby govt hospital [ on this date these two merdicines are given only in govt hospital,other private hospital only has this facility of giving these medicines at a differnt date later than 30 / 03 / 2015], So we choose the nearby govt hospital].I am up loading two documents . The first document is the record given from govt hospital after administrion of oral polio and inj bcg [30/04/2015] That is marked in the first box of the document. In the second box they have marked 45 days and a word starting by letter P[dont know what that word meant]. What ever may be this vaccine is this 45 days mentioned mean 45 days after actual delivery or after giving the first vaccine on 30/04/2015 or 45 days after due date. When i enquired i came to know that ?hepatitis vaccine should be given before 45 days after delivery and after 30 days of the first vaccine[30/4/2015. Is this correct? Now doctor you know the vaccines givesn and dates then i want to know when shall we give the next [second]vacination and what all vaccine to give?As mentioned earlier hepatitis vaccine was not given at the time of birth or the first vaccination date[30-04-2015]. The second document uploaded is a copy of immunisation progarme schdule in XXXXXXX Ther they have mentioned hepatitis vaccine at birth then hepatitis vaccine2 between 6/ 8 weeks etc. In our case we have not taken hepatitis vaccine yet. When is the apt date to take Hepatitis vaccine ,dpt vaccine and opv2 ?. in the second document they have mentioned XXXXXXX govt recomendation , iap recommendation etc . what is this mean.Is it necessary to take thies vaccine for child living in XXXXXXX Kindly go throug the second document and recommend a immunisation schedule[ [date / month/ year] for our baby?
Brief Answer:
Correction for prematurity is recommended
Detailed Answer:
Thanks for asking on HealthcareMagic.
I have carefully gone through your query. Let me try to answer them one by one:
* The corrected gestational age is calculated from the expected date of delivery (EDD) (due date) and not from the birth date. This adjustment is requred upto 2 years of age following which calculation based on birth date is sufficient. It would apply to developmental milestones and also immunisation schedule. I would prefer using the EDD for calculation of the date of immunisation. However, although incorrect, often this adjustment is not done with respect to immunisation. That should not be a major concerning factor.
* The immunisation chart to be followed is as on:
http://indianpediatrics.net/oct2014/785.pdf
Some local variations may be there but that too should not be a major concerning factor. I would suggest remaining under the supervision of a single centre and to follow the immunisation schedule followed there. In order to avoid fuss, please administer the second dose following the norms of the centre at which you are vaccinating.
* Generally Hepatitis B vaccine is administered within the first 15 days of birth.
* Rh incompatibility or incompatility between +ve blood group of a child and -ve blood group of the mother, can give rise to neonatal jaundice. However that should not be a subsequent cause of concern if it has been managed properly in the first place. I would suggest Rh isoimmunisation of the mother to protect the offspring in a subsequent pregnacy.
* For monitoring development, the most basic milestones to look for, would be:
Social smile : achieved by 2 months of age (all ages calculated as per EDD)
Head holding : 4 months
Sitting alone : 8 months
Standing alone : 12 months
If the respective milestone has not been achieved by the mentioned age, there is developmental delay which indicates developmental support is necessary.
Hope that helps.
Regards
Dr. Diptanshu Das
Correction for prematurity is recommended
Detailed Answer:
Thanks for asking on HealthcareMagic.
I have carefully gone through your query. Let me try to answer them one by one:
* The corrected gestational age is calculated from the expected date of delivery (EDD) (due date) and not from the birth date. This adjustment is requred upto 2 years of age following which calculation based on birth date is sufficient. It would apply to developmental milestones and also immunisation schedule. I would prefer using the EDD for calculation of the date of immunisation. However, although incorrect, often this adjustment is not done with respect to immunisation. That should not be a major concerning factor.
* The immunisation chart to be followed is as on:
http://indianpediatrics.net/oct2014/785.pdf
Some local variations may be there but that too should not be a major concerning factor. I would suggest remaining under the supervision of a single centre and to follow the immunisation schedule followed there. In order to avoid fuss, please administer the second dose following the norms of the centre at which you are vaccinating.
* Generally Hepatitis B vaccine is administered within the first 15 days of birth.
* Rh incompatibility or incompatility between +ve blood group of a child and -ve blood group of the mother, can give rise to neonatal jaundice. However that should not be a subsequent cause of concern if it has been managed properly in the first place. I would suggest Rh isoimmunisation of the mother to protect the offspring in a subsequent pregnacy.
* For monitoring development, the most basic milestones to look for, would be:
Social smile : achieved by 2 months of age (all ages calculated as per EDD)
Head holding : 4 months
Sitting alone : 8 months
Standing alone : 12 months
If the respective milestone has not been achieved by the mentioned age, there is developmental delay which indicates developmental support is necessary.
Hope that helps.
Regards
Dr. Diptanshu Das
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Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Answered by
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