A study to assess the knowledge and practice of initiation of immunisation in mothers of low birth weight Neonatal Intensive Care Unit (NICU) graduates in a tertiary care centre


  • Prachi Shailesh Gandhi Department of Neonatology and Pediatrics, Nowrosjee Wadia Maternity Hospital and B. J. Wadia Children’s Hospital, Mumbai, Maharashtra, India
  • Vaidehi Dande Department of Neonatology and Pediatrics, Nowrosjee Wadia Maternity Hospital and B. J. Wadia Children’s Hospital, Mumbai, Maharashtra, India




Immunisation, Knowledge, Low birth weight, Mothers, Practice, Preterm


Background: Premature and low birth weight (LBW) infants are susceptible to infections including those which are preventable. The coverage of immunization in this subset of babies is poor. The present pilot study was an attempt to identify factors which lead to delay in initiation of immunization in this vulnerable group. The objective of this study was to assess knowledge and practice of initiation of immunization in mothers of low birth weight (<2 Kg) NICU graduates and effect of specific counselling on the practice of immunization.

Methods: A prospective pilot study was done between 1st April to 30th June 2016. In the first phase, mothers of LBW and preterm babies were assessed using 2 validated questionnaires on discharge and in High-Risk OPD. In the second phase, a different set of mothers were assessed similarly but counseled specifically by the principal investigator to initiate immunization irrespective of the weight and chronological age. Results were interpreted using the Fischer Exact test, Independent T-test and McNemar.

Results: Among 30 babies in the study, 16 (53.33%) were immunized, of which 6 (37.5%) babies had a timely initiation. Birth weight and duration of NICU stay significantly affected the time of initiation of immunization. There was a significant lack of knowledge in mothers of non-immunized babies. When counseled by the primary investigator, 85.8% and 50% of mothers agreed that immunization can be initiated at birth and even if birth weight is less than 2 kg respectively.

Conclusions: Immunization initiation was delayed in most of the preterm and low birth weight babies. Post counseling a favorable change was observed in mothers’ knowledge but not practice.



Bonhoeffer J, Siegrist C, Heath PT. Immunisation of premature infants. Arch Dis Child. 2006;91(11):929-35.

Immunization in Special Clinical Circumstances In: Kimberlin DW, Brady MT, Jackson MA, Long SS eds. Red Book. 30th ed. American Academy of Pediatrics; 2015:68-70.

Langkamp DL, Langhough R. Primary care physicians’ knowledge about diphtheria-tetanus-pertussis immunizations in preterm infants. Pediatrics. 1992;89(1):52-5.

Pullan CR, Hull D. Routine immunization of preterm infants. Arch Dis Child. 1989;64(10):1438-41.

Roper J, Day S. Uptake of immunisations in low birthweight infants. Arch Dis Child. 1988;63(5):518-21.

Langkamp DL, Langhough R. What do parents of preterm infants know about diphtheria, tetanus, and pertussis immunizations? Am J Perinatol. 1993;10(3):187-9.

Magoon MW, Belardo LJ, Caldito G. Delays in immunizations of high-risk infants during the first two years of life: special care for the high-risk infant should not mean special immunization schedules. J Perinatol Off J Calif Perinat Assoc. 1995;15(3):222-8.

Bernbaum JC, Daft A, Anolik R, Samuelson J, Barkin R, Douglas S, et al. Response of preterm infants to diphtheria-tetanus-pertussis immunizations. J Pediatr. 1985;107(2):184-8.

Vikram K, Vanneman R, Desai S. Linkages between maternal education and childhood immunization in India. Soc Sci Med. 2012;75(2):331-9.

Angelillo IF, Ricciardi G, Rossi P, Pantisano P, Langiano E, Pavia M. Mothers and vaccination: knowledge, attitudes, and behaviour in Italy. Bull World Health Organ. 1999;77(3):224-9.

Omole MK, Owodunni KO. Mothers’ knowledge of immunization programme and factors influencing their compliance at a children hospital in South West Nigeria. J Pharmaceutical Biomed Sci. (JPPMS). 2012;21:1-4.

Hobcraft JN, McDonald JW, Rutstein SO. Socio-economic factors in infant and child mortality: a cross-national comparison. Popul Stud. 1984;38:193-223.

Nath B, Singh JV, Awasthi S, Bhushan V, Kumar V, Singh SK. A study on determinants of immunization coverage among 12-23 months old children in urban slums of Lucknow district, India. Indian J Med Sci. 2007;61(11):598-606.

Corsi DJ, Bassani DG, Kumar R, Awasthi S, Jotkar R, Kaur N, et al. Gender inequity and age-appropriate immunization coverage in India from 1992 to 2006. BMC Int Health Hum Rights. 2009;9(1):S3.

Bhat PNM, Zavier AJF. Fertility decline and gender bias in. Demography. 2003;40(4):637-57.

Hobcraft JN, McDonald JW, Rutstein SO. Socio-economic factors in infant and child mortality: a cross-national comparison. Population Studies. 1984;38(2):193-223

Pande RP. Selective gender differences in childhood nutrition and immunization in rural India: the role of siblings. Demography. 2003;40(3):395-418.

Davis RL, Rubanowice D, Shinefield HR, Lewis N, Gu D, Black SB, et al. Immunization levels among premature and low-birth-weight infants and risk factors for delayed up-to-date immunization status. Centers for Disease Control and Prevention Vaccine Safety Datalink Group. JAMA. 1999;282(6):547-53.

Qutaiba B Al-lela O, Bahari MB, Al-Qazaz HK, Salih MRM, Jamshed SQ, Elkalmi RM. Are parents’ knowledge and practice regarding immunization related to pediatrics’ immunization compliance? a mixed method study. BMC Pediatr. 2014;14:20.

Angadi MM, Jose AP, Udgiri R, Masali KA, Sorganvi V. A study of knowledge, attitude and practices on immunization of children in urban slums of bijapur city, karnataka, India. J Clin Diagn Res JCDR. 2013;7(12):2803-6.

Zagminas K, Surkiene G, Urbanovic N, Stukas R. Parental attitudes towards children’s vaccination. Med Kaunas Lith. 2007;43(2):161-9.

Vohr BR, Oh W. Age of diphtheria, tetanus, and pertussis immunization of special care nursery graduates. Pediatr. 1986;77(4):569-71.






Original Research Articles