Treatment for Preterm Infant Born to Mother with Measles

Immediate Management of the Exposed Preterm Infant

Administer immune globulin (IG) at 0.5 mL/kg intramuscularly to the preterm infant immediately, as infants born to mothers diagnosed with measles lack protective maternal antibodies and are at high risk for severe congenital measles infection, according to the Centers for Disease Control and Prevention (CDC) 1, 2
Administer IG at 0.5 mL/kg (maximum 15 mL) intramuscularly as soon as possible after birth if the mother has active measles infection at delivery or developed measles shortly before delivery, as recommended by the American Academy of Pediatrics (AAP) 2
The higher dose of 0.5 mL/kg is indicated for immunocompromised individuals, and preterm infants fall into this category due to their immature immune systems and lack of adequate transplacental antibody transfer, according to the Infectious Diseases Society of America (IDSA) 2
IG must be given within 6 days of exposure to be effective in preventing or modifying measles infection, as stated by the World Health Organization (WHO) 2

Administer measles vaccine (monovalent measles or MMR) at 6 months of age to the preterm infant, as this has been shown to induce sufficient serological responses in preterm infants without serious adverse events, according to the CDC 1
If IG was administered, delay measles vaccination until 5-6 months after IG administration to avoid interference with vaccine immunogenicity from passively acquired antibodies, as recommended by the AAP 2
Any measles vaccine given before 12 months of age does not count toward the routine two-dose series, according to the CDC 1
Administer the first official dose of MMR at 12 months of age (or as soon as possible after reaching 12 months), followed by a second dose at least 28 days later, as recommended by the CDC and the AAP 1, 3

Do not delay IG administration while waiting for laboratory confirmation of maternal measles—clinical diagnosis in the mother is sufficient to warrant prophylaxis for the infant, as stated by the IDSA 2
Do not use the standard 0.25 mL/kg IG dose for preterm or immunocompromised infants; the higher 0.5 mL/kg dose is required for adequate protection, according to the WHO and the AAP 2
Do not assume that any measles vaccine given before 12 months counts toward the routine series—these infants must still receive two additional doses starting at 12 months, as recommended by the CDC and the AAP 1
Do not confuse measles (rubeola) with rubella (German measles)—IG is not indicated for rubella exposure, and the clinical presentations and complications differ significantly, according to the CDC and the WHO 2
Do not forget to vaccinate the infant 5-6 months after IG administration—failure to do so leaves the infant vulnerable to future measles exposures, as stated by the AAP and the IDSA 2