A NICU Expert Answers Parents’ Questions About Infant Immunity

Parents often hear the term “medically fragile,” but they may not always understand what it means or why it matters. While many infants are born healthy, others face higher risks due to premature birth or underlying medical conditions. Understanding these vulnerabilities can help families make informed decisions about protecting their children and those around them.

Tamara Hryshchuk, DNP, RNC-NIC, director of the ABSN program and clinical assistant professor of nursing at the University of Tulsa, has spent 17 years working in neonatal intensive care units (NICUs) and is a nationally certified NICU nurse and Neonatal Resuscitation Program instructor. Through her work caring for some of the most vulnerable newborns, she has seen firsthand how infections can affect medically fragile infants.

Below, Hryshchuk answers common questions parents may have about infant health, vaccines and how to have productive conversations with pediatricians.

We often hear the phrase “medically fragile.” For parents with healthy infants, why is it still important to understand the risks faced by these vulnerable children?

Tamara Hryshchuk, DNP, RNC-NIC: Medically fragile infants are usually babies who were born prematurely or with an underlying health condition that can make their immune systems weaker and less developed than babies who are born healthy.

When healthy babies receive immunizations and are well protected, it can help protect those more vulnerable infants who may not yet be able to receive certain vaccines or who have fragile immune systems. It creates an extra layer of protection for those babies because the people around them are less likely to carry illnesses that could be dangerous for them.

When parents come to you with hesitation or conflicting information they’ve found online, what is the best way to start that conversation?

TH: It’s important for clinicians to remember that parents are their children’s advocates. That is their role and responsibility as a mother, father or caregiver.

Sometimes parents are trying to interpret information they found online and may not fully understand it. Starting the conversation with curiosity can help. Clinicians can ask questions such as: What were you looking for? What did you find? What were you hoping to learn?

Approaching the conversation this way keeps it open and respectful. If misinformation comes up, it becomes an opportunity to provide accurate information rather than creating frustration or shutting the conversation down.

Many parents worry about overwhelming a newborn’s immune system. How do you explain how vaccines interact with a baby’s immune system?

TH: Most babies spend eight or nine months developing in a very protected environment inside their mother’s womb. Once they’re born, they’re suddenly exposed to the outside world.

They begin breathing air, people are touching them, they’re lying on blankets and beds, and they’re immediately exposed to bacteria, viruses and germs that their bodies have never encountered before.

Vaccines are designed to help the immune system learn how to respond to those threats. They contain very small doses that train the immune system so that if a baby is later exposed to the real virus or bacteria, the body already knows how to respond.

Because babies are already encountering many new exposures after birth, vaccines are not overwhelming the immune system; they are helping prepare it.

Some parents feel intimidated talking with their pediatrician. What questions should every parent feel empowered to ask about immunizations?

TH: One of the most important steps is choosing a pediatrician who will support open communication with parents and respect their role in making decisions for their child.

Once those conversations start, parents should feel comfortable asking what each vaccine protects against. Many vaccines are referred to by abbreviations that may not be familiar to families.

For example, parents might ask: What is the MMR vaccine? What diseases does it protect against?

It can also be helpful to ask how a particular illness could affect their child if they were to get it. Every child is different. A medically fragile infant may face different risks than a healthy toddler or preschooler.

Understanding how a disease could impact their specific child can help parents make more informed decisions.

If you could leave every new parent with one perspective about vaccines and the children you care for, what would it be?

TH: Health care providers strongly advocate for vaccines, but we know that not every family will make the same decision.

Over the years, many clinicians have seen serious infections and the consequences those illnesses can have for children. In some cases, those infections might have been less severe if the child had been vaccinated.

Vaccination is a way to protect children from certain diseases, and it can also help protect other people in the community. Understanding that shared protection can be an important part of the conversation for many families.

This transcript was edited for clarity.