An update on vaccination in preterm infants

Abstract Objective: The objective of this article is to review the most current literature on vaccines, focusing on their safety, immunogenicity, and efficacy in preterm newborns, aiming to improve vaccine coverage in this population. Data source: Most recent scientific publications addressing the immunization of preterm newborns. Data synthesis: Despite its immunological immaturity, vaccination is well tolerated by preterm infants, and protective immune responses are observed, but some studies have shown that preterm infants undergo unjustified delays in their vaccination schedule. Conclusions: Despite being widely recommended, the routine immunization of preterm infants is often delayed, putting this vulnerable population at risk for several diseases, many of which are preventable by immunization. Every effort should be made to develop universal guidelines that define the immunization of preterm infants.

Chronic medical conditions associated with invasive pneumococcal diseases in inpatients in teaching hospitals in São Paulo city: Estimating antimicrobial susceptibility and serotype-coverage of pneumococcal vaccines

Background: Chronic conditions increase the risk of invasive pneumococcal diseases (IPD). Pneumococcal vaccination remarkably reduced IPD morbimortality in vulnerable populations. In Brazil, pneumococcal vaccines are included in the National Immunization Program (PNI): PCV10 for < 2 years-old, and PPV23 for high risk-patients aged ≥ 2 years and institutionalized ≥ 60 years. PCV13 is available in private clinics and recommended in the PNI for individuals with certain underlying conditions. Methods: A retrospective study was performed using clinical data from all inpatients from five hospitals with IPD from 2016 to 2018 and the corresponding data on serotype and antimicrobial-non-susceptibility of pneumococcus. Vaccine-serotype-coverage was estimated. Patients were classified according to presence of comorbidities: healthy, without comorbidities; at-risk, included immunocompetent persons with specific medical conditions; high-risk, with immunocompromising conditions and others RESULTS: 406 IPD cases were evaluated. Among 324 cases with information on medical conditions, children < 5 years were mostly healthy (55.9%), while presence of comorbidity prevailed in adults ≥ 18 years old (> 82.0%). Presence of ≥1 risk condition was reported in ≥ 34.8% of adults. High-risk conditions were more frequent than at-risk in all age groups. Among high-risk comorbidity (n = 211), cancer (28%), HIV/AIDS (25.7%) and hematological diseases (24.5%) were the most frequent. Among at-risk conditions (n = 89), asthma (16.5%) and diabetes (8.1%) were the most frequent. Among 404 isolates, 42.9% belonged to five serotypes: 19A (14.1%), 3 (8.7%), 6C (7.7%), 4 and 8 (6.2% each); 19A and 6C expressed antimicrobial-non-susceptibility. The vaccine-serotype-coverage was: PCV10, 19.1%, PCV13, 43.8%; PCV15, 47.8%; PCV20, 62.9%; PCV21, 65.8%, and PPV23, 67.3%. Information on hospital outcome was available for 283 patients, of which 28.6% died. Mortality was 54.2% for those with meningitis. Conclusion: Vaccine with expanded valence of serotypes is necessary to offer broad prevention to IPD. The present data contribute to pneumococcal vaccination public health policies for vulnerable patients, mainly those with comorbidity and the elderly. Keywords: Antimicrobial resistance; Chronic diseases; Comorbidity; Invasive pneumococcal diseases; Pneumococcal conjugate vaccine; Pneumococcal serotypes; Pneumococcal vaccine.

Chronic medical conditions associated with invasive pneumococcal diseases in inpatients in teaching hospitals in São Paulo city: Estimating antimicrobial susceptibility and serotype-coverage of pneumococcal vaccines

ABSTRACT Background: Chronic conditions increase the risk of invasive pneumococcal diseases (IPD). Pneumococcal vaccination remarkably reduced IPD morbimortality in vulnerable populations. In Brazil, pneumococcal vaccines are included in the National Immunization Program (PNI): PCV10 for < 2 years-old, and PPV23 for high risk-patients aged ≥ 2 years and institutionalized ≥ 60 years. PCV13 is available in private clinics and recommended in the PNI for individuals with certain underlying conditions. Methods: A retrospective study was performed using clinical data from all inpatients from five hospitals with IPD from 2016 to 2018 and the corresponding data on serotype and antimicrobial-non-susceptibility of pneumococcus. Vaccine-serotype-coverage was estimated. Patients were classified according to presence of comorbidities: healthy, without comorbidities; at-risk, included immunocompetent persons with specific medical conditions; high-risk, with immunocompromising conditions and others Results: 406 IPD cases were evaluated. Among 324 cases with information on medical conditions, children < 5 years were mostly healthy (55.9%), while presence of comorbidity prevailed in adults ≥ 18 years old (> 82.0%). Presence of ≥1 risk condition was reported in ≥ 34.8% of adults. High-risk conditions were more frequent than at-risk in all age groups. Among high-risk comorbidity (n = 211), cancer (28%), HIV/AIDS (25.7%) and hematological diseases (24.5%) were the most frequent. Among at-risk conditions (n = 89), asthma (16.5%) and diabetes (8.1%) were the most frequent. Among 404 isolates, 42.9% belonged to five serotypes: 19A (14.1%), 3 (8.7%), 6C (7.7%), 4 and 8 (6.2% each); 19A and 6C expressed antimicrobial-non-susceptibility. The vaccine-serotype-coverage was: PCV10, 19.1%, PCV13, 43.8%; PCV15, 47.8%; PCV20, 62.9%; PCV21, 65.8%, and PPV23, 67.3%. Information on hospital outcome was available for 283 patients, of which 28.6% died. Mortality was 54.2% for those with meningitis. Conclusion: Vaccine with expanded valence of serotypes is necessary to offer broad prevention to IPD. The present data contribute to pneumococcal vaccination public health policies for vulnerable patients, mainly those with comorbidity and the elderly.

Custo-efetividade da vacina contra influenza quadrivalente baseada em células comparada com a trivalente baseada em ovo do Programa Nacional de Imunizações brasileiro / Cost-effectiveness of cell-based quadrivalent versus egg-based trivalent influenza vaccination in the Brazilian National Immunization Program

Objetivos: Este estudo teve como objetivo avaliar desfechos clínico-econômicos associados à vacina contra influenza quadrivalente baseada em células (QIVc) versus a vacina trivalente atualmente utilizada (TIVe) para prevenção sazonal de influenza no Programa Nacional de Imunizações (PNI) brasileiro. Métodos: Um modelo estático de árvore de decisão foi usado. Considerou-se um total de 54.071.642 indivíduos vacinados em 2019; a circulação de influenza por subtipo foi baseada em dados de vigilância epidemiológica. A efetividade da vacina (EV) TIVe foi extraída de metanálises publicadas; já a EV relativa da QIVc foi retirada de um estudo observacional retrospectivo. A incompatibilidade antigênica da vacina com vírus circulantes foi baseada em fontes retrospectivas internacionais. O uso de recursos baseou-se em estudos do mundo real. Custos unitários foram retirados de tabelas-padrão publicados em 2019 em reais (BRL). Resultados: Substituir a TIVe pela QIVc pode evitar, anualmente, casos sintomáticos (452.065) e reduzir visitas ambulatoriais (118.735), hospitalizações (15.466), mortes (2.753), custos médicos (-BRL 46.677.357) e custos indiretos (-BRL 59.962.135). O número anual de anos de vida ajustados por qualidade de vida (QALYs) pode aumentar em 96.129. Resultados de base a partir da perspectiva do pagador mostram uma razão de custo-efetividade incremental (RCEI) de BRL 17.293/QALY e, da perspectiva da sociedade, o RCEI obtido foi de um ganho de BRL 16.669/QALY. Usando o Produto Interno Bruto (PIB) brasileiro como um limiar (BRL 34.533/QALY), trocar a TIVe pela QIVc no PNI pode ser uma estratégia altamente custo-efetiva. Conclusões: O uso da QIVc pelo PNI tem potencial para ser altamente custo-efetivo tanto da perspectiva do pagador quanto da sociedade

Objectives: This study aimed to estimate health and economic outcomes associated to cell-based quadrivalent influenza vaccine (QIVc) versus current trivalent influenza vaccines (TIVe) for seasonal influenza prevention in the Brazilian National Immunization Program (NIP), from the societal and public payer perspectives. Methods: A 1-year static decision-tree model based on literature was used. 54,071,642 total vaccinated individuals in 2019 were considered; influenza subtype circulation was based on Brazilian epidemiologic data (2009-2019). TIVe vaccine effectiveness (VE) was extracted from a published meta-analysis and QIVc relative VE from an international retrospective observational study. A/H3N2 egg-adaptation and B mismatch to recommended strain were gathered from international retrospective sources. Resource use was obtained from real-world studies. Inputs were adjusted to influenza subtype and multiple age groups with Brazilian literature. Unit costs were retrieved from published standard tables in 2019 Brazilian Reais (BRL). Results: Replacing TIVe with QIVc, can annually avert symptomatic cases (452,065) and reduce outpatient visits (118,735); hospitalizations (15,466), deaths (2,753), overall medical direct costs (-BRL 46,677,357) and indirect costs (-BRL 59,962,135). The annual number of quality-adjusted life-years (QALYs) could be increased by 96,129. Base case results from the payer perspective show an incremental cost-effectiveness ratio (ICER) of BRL 17,293/QALY gained and from the societal perspective the ICER obtained was BRL 16,669/QALY gained. Using the Brazilian Gross Domestic Product (GDP) as a threshold (BRL 34,533/QALY) switching TIVe with QIVc in the NIP can be a highly cost-effective strategy, leading to a high QALY increment and preventing medical and indirect costs. Conclusions: The use of QIVc by the NIP has the potential to be highly cost-effective in the payer and society perspective

Imunizações em pacientes com doenças raras ­ Posicionamento conjunto da Sociedade Brasileira de Imunizações (SBIm), Associação Brasileira de Alergia e Imunologia (ASBAI) e Sociedade Brasileira de Pediatria (SBP) / Immunizations in patients with rare diseases ­ A joint position statement of the Brazilian Society of Immunizations (SBIm), Brazilian Association of Allergy and Immunology (ASBAI), and Brazilian Society of Pediatrics (SBP)

Introdução: De acordo com a Organização Mundial da Saúde, a prevalência de doenças raras (abaixo de 65 casos/100.000 habitantes) é de 6%, e variável na dependência da população em estudo. Há 6.172 doenças raras (DR) catalogadas. Esquemas vacinais específicos para DR não estão disponíveis no Brasil, e esta orientação é limitada na maioria dos países. Objetivos: Identificar e propor esquemas específicos de imunização para pacientes com DR, tendo-se em conta segurança e eficácia. Fonte de dados: Revisão não sistemática da literatura, com busca de artigos de 2000 a 2020 no PubMed, Google Scholar, SciELO e Orphanet usando os termos "rare diseases" ou "inborn errors of metabolism" ou "cystic fibrosis" ou "inborn errors of immunity" e "vaccines" ou "immunization" ou "vaccination", nos idiomas inglês, francês, espanhol e português. Conclusões: A imunização de pessoas com DR é tema complexo, com poucas recomendações publicadas a este respeito, e na maioria das vezes realizada de modo empírico. É importante que a equipe médica que acompanha esses pacientes tenha um olhar abrangente e proporcione a prevenção mais completa possível.

Background: According to the World Health Organization, the prevalence of rare diseases (below 65 cases/100 000 population) is 6% and may vary depending on the study population. There are 6172 rare diseases (RD) listed. RD-specific vaccine schemes are not available in Brazil, and guidance is limited in most countries. Objectives: To identify and propose specific immunization schemes for RD patients, valuing safety and efficacy. Data source: A nonsystematic literature review was conducted, with search for articles from 2000 to 2020 on PubMed, Google Scholar, SciELO, and Orphanet with the terms "rare diseases" or "inborn errors of metabolism" or "cystic fibrosis" or "inborn errors of immunity" and "vaccines" or "immunization" or "vaccination," in English, French, Spanish, and Portuguese languages. Conclusions: Immunization of RD patients is a complex topic with few published recommendations, most often produced empirically. The medical teams following up these patients should have a more comprehensive insight and provide the most complete prevention possible.

Vaccines for COVID-19 - state of the art / Vacinas para COVID-19 - o estado da arte

Abstract Vaccine candidates against COVID-19 have diverse compositions, from traditional inac-tivated virus vaccines to various new-generation vaccines. Currently, approximately 175 research teams worldwide are studying various vaccine possibilities as the necessityto vacci-nate the entire population against the SARS-CoV-2 virus is urgent. Although, the development of a safe and effective COVID-19 vaccine is not easy, the manufacturing, distribution, and administration of the vaccine can also face extraordinary challenges. In this review, we enhance some of the current knowledge regarding the clinical trial phases on different COVID-19 vaccine candidates, its potential strengths and disadvantages, and to discuss ethical aspects and their chances of success in large-scale applications.

Resumo As vacinas candidatas contra COVID-19 têm diversas composições, desde vacinas de vírus inativados a várias de nova geração. Atualmente, cerca de 175 equipes de pesquisa em todo o mundo estão estudando diversas possibilidades, visto que a necessidade de vacinar toda a população contra o vírus SARS-CoV-2 é urgente. Embora o desenvolvimento de uma vacina COVID-19 segura e eficaz não seja fácil, a fabricação, distribuição e administração também podem enfrentar desafios extraordinários. Nesta revisão, destacamos alguns dos conhecimentos atuais sobre as fases dos ensaios clínicos de diferentes vacinas candidatas COVID-19, seus potenciais pontos fortes e desvantagens, e discutimos os aspectos éticos e suas chances de sucesso em aplicações em grande escala.

Capsular genotype distribution of Group B Streptococcus colonization among at-risk pregnant women in Sao Paulo, Brazil

ABSTRACT Background: Vaccines in development against Group B Streptococcus (GBS) should contain the most prevalent capsular genotypes screened in the target population. In low- and middle-income countries epidemiological data on GBS carriage among pregnant women, a prerequisite condition for GBS neonatal sepsis, is needed to inform vaccine strategies. Objective: To investigate the prevalence of different GBS capsular genotypes that colonizes at-risk pregnant women in a private maternity hospital in São Paulo, Brazil. Methods: GBS strains isolated in routine maternity procedures from at-risk pregnant women from 2014 to 2018 were confirmed by mass spectrometry (MALDI-TOF) with subsequent DNA extraction for identification of capsular genotype through polymerase chain reaction (PCR). Demographic and gestational data were analyzed. Results: A total of 820 Todd-Hewitt broths positive for GBS were selected for streptococcal growth. Recovery and confirmation of GBS by MALDI-TOF were possible in 352. Strains were processed for determination of capsular genotype by PCR. From the total of 352 GBS isolates, 125 strains (35.5%) were genotyped as Ia; 23 (6.5%) as Ib; 41 (11.6%) as II; 36 (10.2%) as III; 4 (1.1%) as IV; 120 (34.1%) as V and 1 strain (0.3%) as VIII. Two isolates (0.7%) were not genotyped by used methodology. No statistically significant correlation between gestational risk factors, demographic data and distribution of capsular genotypes were found. Conclusions: GBS capsular genotypes Ia, Ib, II, III, and V were the most prevalent isolates colonizing at risk pregnant women in the present study. The inclusion of capsular genotypes Ia and V in the composition of future vaccines would cover 69.6% of capsular genotypes in the studied population. No statistically significant differences were observed between capsular genotype and gestational and demographic data and risk factors.

Guia prático de abordagem da criança e do adolescente com asma grave: Documento conjunto da Associação Brasileira de Alergia e Imunologia e Sociedade Brasileira de Pediatria / Practical guide to approaching children and adolescents with severe asthma: a joint document of the Brazilian Association of Allergy and Immunology and the Brazilian Society of Pediatrics

Asma grave é a asma que requer tratamento com altas doses de corticosteroide inalado associado a um segundo medicamento de controle (e/ou corticosteroide sistêmico) para impedir que se torne "descontrolada" ou permaneça "descontrolada" apesar do tratamento. Asma grave é considerada um subtipo de asma de difícil tratamento. A prevalência em crianças evidenciada pelo International Study of Asthma and Allergies in Childhood variou entre 3,8% e 6,9%. Existem diversos instrumentos para avaliação subjetiva, como diários de sintomas e questionários, bem como para avaliação objetiva com função pulmonar e avaliação da inflamação por escarro induzido, ou óxido nítrico exalado. A abordagem terapêutica varia desde doses altas de corticosteroide inalado e/ou oral, broncodilatadores de longa duração, antaganonistas de receptores muscarínicos, até os mais recentes imunobiológicos que bloqueiam a IgE ou IL-5.

Severe asthma is asthma that requires treatment with high doses of inhaled corticosteroids in combination with a second control drug (and/or a systemic corticosteroid) to prevent it from becoming "uncontrolled" or remaining "uncontrolled" despite treatment. Severe asthma is considered a difficult-to-treat asthma subtype. The prevalence in children found by the International Study of Asthma and Allergies in Childhood ranged from 3.8% to 6.9%. There are several instruments for subjective assessment, such as symptom diaries and questionnaires, as well as for objective assessment, including pulmonary function testing and evaluation of inflammation by induced sputum or exhaled nitric oxide. The therapeutic approach includes high doses of inhaled and/or oral corticosteroids, long-acting bronchodilators, muscarinic receptor antagonists, and the latest biologics that block IgE or IL-5.

Brazilian recommendations on the safety and effectiveness of the yellow fever vaccination in patients with chronic immune-mediated inflammatory diseases

Abstract Background: In Brazil, we are facing an alarming epidemic scenario of Yellow fever (YF), which is reaching the most populous areas of the country in unvaccinated people. Vaccination is the only effective tool to prevent YF. In special situations, such as patients with chronic immune-mediated inflammatory diseases (CIMID), undergoing immunosuppressive therapy, as a higher risk of severe adverse events may occur, assessment of the risk-benefit ratio of the yellow fever vaccine (YFV) should be performed on an individual level. Main body of the abstract: Faced with the scarcity of specific orientation on YFV for this special group of patients, the Brazilian Rheumatology Society (BRS) endorsed a project aiming the development of individualized YFV recommendations for patients with CIMID, guided by questions addressed by both medical professionals and patients, followed an internationally validated methodology (GIN-McMaster Guideline Development). Firstly, a systematic review was carried out and an expert panel formed to take part of the decision process, comprising BRS clinical practitioners, as well as individuals from the Brazilian Dermatology Society (BDS), Brazilian Inflammatory Bowel Diseases Study Group (GEDIIB), and specialists on infectious diseases and vaccination (from Tropical Medicine, Infectious Diseases and Immunizations National Societies); in addition, two representatives of patient groups were included as members of the panel. When the quality of the evidence was low or there was a lack of evidence to determine the recommendations, the decisions were based on the expert opinion panel and a Delphi approach was performed. A recommendation was accepted upon achieving ≥80% agreement among the panel, including the patient representatives. As a result, eight recommendations were developed regarding the safety of YFV in patients with CIMID, considering the immunosuppression degree conferred by the treatment used. It was not possible to establish recommendations on the effectiveness of YFV in these patients as there is no consistent evidence to support these recommendations. Conclusion: This paper approaches a real need, assessed by clinicians and patient care groups, to address specific questions on the management of YFV in patients with CIMID living or traveling to YF endemic areas, involving specialists from many areas together with patients, and might have global applicability, contributing to and supporting vaccination practices. We recommended a shared decision-making approach on taking or not the YFV.

Vacina rotavírus: segurança e alergia alimentar ­ Posicionamento das Sociedades Brasileiras de Alergia e Imunologia (ASBAI), Imunizações (SBIm) e Pediatria (SBP) / Rotavirus vaccine: safety and food allergy ­ Position paper of the Brazilian Societies of Allergy and Immunology (ASBAI), Immunizations (SBIm), and Pediatrics (SBP)

O rotavírus continua sendo o principal agente causador de diarreia na criança, a despeito da ampla utilização de vacinas nos programas públicos de vacinação em todo o mundo. No Brasil, a vacina monovalente foi introduzida no Programa Nacional de Imunizações (PNI) em 2006, e a segurança da vacina está bem documentada em diferentes estudos pré e pós-licenciamento. Embora não haja nenhuma associação entre o uso da vacina rotavírus e o desenvolvimento da alergia às proteínas do leite de vaca (APLV), existe o receio, por parte de alguns pediatras e familiares, da vacina estar relacionada ao surgimento ou desencadeamento desta reação de hipersensibilidade. Este artigo faz uma revisão dos dados de segurança da vacina e aborda aspectos imunológicos das reações de hipersensibilidade, demonstrando não haver nexo causal entre a vacina e a APLV, reforçando o posicionamento e recomendações de organismos nacionais, internacionais e das sociedades científicas.

Despite the widespread use of vaccines in public immunization programs worldwide, rotavirus remains the primary cause of diarrhea in children. In Brazil, the monovalent vaccine was introduced in the National Immunization Program (Programa Nacional de Imunizações - PNI) in 2006, and its safety is well documented in different studies carried out both before and after licensing. Even though there is no association between the use of rotavirus vaccine and the development of cow's milk protein allergy (CMPA), some pediatricians and family members fear that the vaccine may be somehow related to the emergence or outbreak of this hypersensitivity reaction. This article reviews safety data available for this vaccine and addresses the immunological aspects of hypersensitivity reactions. The findings demonstrate that there is no causal link between the rotavirus vaccine and CMPA, reinforcing the position and recommendations of national and international agencies as well as of scientific societies.

Vacinação contra o vírus influenza em gestantes: cobertura da vacinação e fatores associados / Influenza vaccine in pregnant women: immunization coverage and associated factors

OBJETIVO: Descrever a cobertura vacinal de gestantes para influenza e fatores associados à recusa ou à aceitação da vacina. MÉTODOS: Estudo descritivo, prospectivo, que incluiu 300 puérperas atendidas no Hospital e Maternidade Santa Joana (SP). Os dados foram coletados em outubro de 2010, por meio de questionário pré-testado, aplicado por profissional treinado. RESULTADOS: A média de idade das mães foi 30,5 anos; 231 (77%) eram casadas; 164 (54,7%) primigestas; 192 (64%) tinham nível superior de escolaridade; e 240 (80%) estavam empregadas. Durante o pré-natal, 234 (78%) receberam informação sobre a vacina contra influenza e 287 (95,7%) foram imunizadas; 210 (73,2%) mulheres tinham conhecimento sobre a proteção neonatal pela vacinação materna. Fatores associados à aceitação foram: campanha do governo (133; 44,3%) e recomendação médica durante o pré-natal (163; 54,3%). Entre as 13 grávidas que recusaram a vacinação, as razões foram: negligência (4), falta de tempo (4), falta de indicação médica (3) ou contraindicação pelo médico (2), mas 69,2% teriam sido vacinadas se tivessem sido informadas sobre a proteção neonatal. CONCLUSÃO: O receio da pandemia e a campanha pública tiveram importante impacto na elevada cobertura vacinal para influenza em gestantes. Recomendação médica e campanha do governo foram os principais motivos de aceitação da vacina.

OBJECTIVES: To describe the immunization coverage of the influenza vaccine for pregnant women, and factors associated to vaccination compliance. METHODS: This is a prospective, descriptive study including 300 women who had just given birth at Hospital and Maternity Santa Joana in Sao Paulo, Brazil. Data were collected through a pre-tested questionnaire applied by a trained evaluator during October 2010. RESULTS: The mean age of mothers was 30.5 years; 231 (77%) were married; 164 (54.7%) were primigravidas; 192 (64%) had higher education; and 240 (80%) were employed. During the prenatal period, 234 (78%) received information about the influenza vaccine and 287 (95.7%) were immunized; 210 (73.2%) women knew about neonatal protection achieved through maternal vaccination. The factors associated with maternal acceptance of the vaccine were government campaign (133; 44.3%), and medical recommendation during prenatal visits (163; 54.3%). A total of 13 pregnant women refused vaccination for the following reasons: neglect (4), lack of time (4), lack of recommendation from their physician (3) or contraindication by physician (2), but 69.2% of them would have accepted immunization had they been informed about neonatal protection. CONCLUSIONS: The fear of a pandemic and the public vaccination campaign had an important impact on the high immunization coverage for influenza on pregnant women. Medical recommendation and the government campaign were the main reasons for vaccine compliance.

Controvérsias em imunizações: 2010

As explanações desse evento abordam temas como antitérmicos e vacinações, a vacina tetravalente viral, a vacina contra febre amarela na gestante e na lactação, vacinas contra influenza, a vacina H1N1 e gestação, a relação da síndrome de Guillain-Barré e vacinações. Trata também sobre imunoglobulina humana normal administrada por via intramuscular, vacinas pneumocócicas, intervalo ideal entre as doses de varicela, novas perspectivas na prevenção da doença meningocócica e vacinas contra o vírus do HPV.

Doença respiratória em bebês prematuros / Respiratory disease in preterm infants

As doenças respiratórias são responsáveis pela maioria dos atendimentos em salas de emergência, internações hospitalares e admissões em unidades de terapia intensiva, representando importante problema de saúde pública para qualquer população, por sua elevada demanda, pelos altos custos e pelo uso, muitas vezes, indiscriminado de antimicrobianos. Recém-nascidos prematuros, por suas próprias características físicas, nutricionais e imunitárias, apresentam maior morbidade e mortalidade associadas a essas infecções. Com o crescente aumento no número de partos prematuros, associado à maior sobrevida desses pré-termos, cada vez mais extremos, estratégias de prevenção de infecções respiratórias nesse grupo de pacientes se tornam fundamentais, a fim de se garantir a saúde dessa população, inclusive a longo prazo.Este artigo procura discutir aspectos próprios dos prematuros, suas características imunológicas, as doenças respiratórias mais freqüentes, os principais agentes virais e bacterianos envolvidos, além de abordar aspectos de sua prevenção.