2 month old. Premature 32 week. Irritability after acellular pertussis. No daylight sleep (there is no problem in night sleep). What to do ? Paracetamol ? Dose ? Phenobarbital ? What must be our advice for later vaccines ?

We rel often see some minor instability and irritability when we give the first (extra-dose) vaccin at 2 months in preterm infants. We mostly wait and see until symtoms disappear and sometimes give paracetamol. Although rarely, it happens we need to give HFNC before all is fine again.

I was looking for some current evidence , because I read recently this paper reporting (consistently with the previous knowledge) increased odds of apneic events following 2-month vaccinations in preterm infants (TL,DR "In hospitalized preterm infants, the odds of apnea within 48 hours were higher after 2-month vaccinations vs after no vaccinations. The similar number and duration of apneic events and lack of serious adverse events suggest that current vaccination recommendations for hospitalized preterm infants are appropriate. Neonatal clinicians should continue providing evidence-based anticipatory guidance about postvaccination apnea risk. https://jamanetwork.com/journals/jamapediatrics/article-abstract/2828426).

However, the only paper I found, which reports increased irritability after pertussis vaccination, is from1985 : https://pubmed.ncbi.nlm.nih.gov/3874942/ Response of preterm infants to diphtheria-tetanus-pertussis immunizations - so that was whole-cell pertussis vaccine. Do you have any more current reading material on this topic?

Seven days irritability was an important problem for family. They were near exhausted. What to do in next vaccines ? Good expectations ? Paracetamol before vaccination ? A tired week again ?

Preterm infants getting unstable "than expected" at their vaccination at 2 months (the extra dose we give in the NICU), we sometimes give the first regular vaccination (3 months of chronological age) at our hospital policlinc, and make the family wait 2-3 hours after the vaccination.

I have not experienced that any infants has become unstable, but we offer this as an extra precaution, and as a bonus, we do not loose the "credibility" of vaccinations as such. The second regular dose, at 5 months chronological age, is then given at the regular child care center where all other children get the vaccinations.

In my experience, this works well for everyone, the infant, the parents and for us :)