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In June 2023, we commenced a project to review and update the Maternity and Neonatal eHandbook guidelines with a view to completion in 2024. Please be aware that pending this review, some of the current guidelines may be out of date. In the meantime, we recommend that you also refer to more contemporaneous evidence.

Key messages

  • Immunise preterm infants according to the recommended schedule based on their chronological age as opposed to their corrected age.
  • Vaccines, other than Hepatitis B, should be commenced from 6 weeks of age (Day 42) and where possible, be given prior to discharge from hospital.
  • Preterm infants have a special need for protection against infectious agents such as pertussis.
  • Preterm infants may not mount a sufficient antibody response to some vaccines and will require additional boosters (pneumococcal vaccine in <28 weeks, hepatitis B vaccine in <32 weeks’ and <2000g).
  • Annual influenza vaccine recommended from ≥6 months chronological age.
  • Immunisation for preterm infants with Chronic Lung Disease receiving postnatal corticosteroids is recommended:
    • According to the DART regime 1, a 10 day tapering regimen with a total dose of 890micrograms/kg, there is no contraindication for live vaccines as the steroid dose does not reach a level of concern for immunocompromise. Immunisations, including rotavirus, can be administered at any time.
    • According to the Cumming’s regime 2, a 42 day tapering regimen commencing at 500micrograms/kg of dexamethasone, timing of immunisation for rotavirus needs to be considered. It is safe to consider rotavirus immunisation once on <1mg/kg/day prednisolone equivalent dosing of steroid, and >2 weeks since being on >2mg/kg/day prednisolone equivalent dosing (or from day 25 of 42 day protocol onward, on dose of 70 micrograms/kg dexamethasone BD).
    • Australian Immunisation Handbook Rotavirus information 

Our guidance

Safer Care Victoria endorses the vaccination for preterm infants guidance in the Australian Immunisation Handbook.

Additional information about vaccination of infants and children can be found on the Victorian Department of Health website as well as information about the Victorian immunisation schedule and vaccine eligibility criteria.


  1. Doyle LW, Davis PG, Morley CJ, McPhee A, Carlin JB. Low-dose dexamethasone facilitates extubation among chronically ventilator-dependent infants: a multicenter, international, randomized, controlled trial. Pediatrics. 2006 Jan 1;117(1):75-83. DOI: 10.1542/peds.2004-2843
  2. Cummings JJ, D'Eugenio DB, Gross SJ. A controlled trial of dexamethasone in preterm infants at high risk for bronchopulmonary dysplasia. New England Journal of Medicine. 1989 Jun 8;320(23):1505-10. DOI: 10.1056/NEJM198906083202301

Get in touch

Clinical Guidance Team
Safer Care Victoria

Version history

First published: August 2017
Review due by: June 2025

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