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Please note that all guidance is currently under review and some may be out of date. We recommend that you also refer to more contemporaneous evidence in the interim.
Intramuscular (IM) injections in neonates may be required to administer medications or vaccines.
The anterolateral thigh is the preferred site for IM injection in infants under 12 months of age. Medications are injected into the bulkiest part of the vastus lateralis thigh muscle, which is the junction of the upper and middle thirds of this muscle.
Nursing and medical staff must be familiar with the principles of the administration of medications to an infant. These principles include:
- observation of standard precautions
- aseptic techniques
- correct drug/dose/time/route/patient practices.
Equipment required
Equipment: required for IM injection includes:
- IM medication ampoule
- large-bore needle for withdrawing medication from ampoule
- 1 mL or 2 mL syringe
- 23 gauge 25 mm needle or 25 gauge 16 mm needle for preterm babies two months or younger (see table below)
- antiseptic swab if used must be allowed to dry before injection given
- cotton wool swab
- gloves for standard precautions.
Recommended needle size, length and angle for administering vaccines
| Preterm babies (< 37 weeks' gestation) up to two months of age and/or very small infants | 23 or 25 gauge,* 16 mm in length | 90° to skin plane |
| Infant, child or adult for IM vaccine | 23 or 25 gauge, 25 mm in length | 90° to skin plane |
| Subcutaneous injection in all infants | 25 or 26 gauge, 16 mm in length | 45° to skin plane |
* If using a narrow 25 gauge needle for an IM vaccination, ensure vaccine is injected slowly over a count of five seconds to avoid injection pain and muscle trauma.
Needle length
The use of short needles for administering IM vaccines may lead to inadvertent SC injection and increase the risk of significant local adverse events, particularly with aluminium-adjuvanted vaccines (for example, hepatitis B, DTPa, DTPa-combination or dT vaccines).
Refer to the Australian Immunisation Handbook 10th edition 2013.
High drug-loaded microspheres enabled by controlled in-droplet precipitation promote functional recovery after spinal cord injury.
Li W, Chen J, Zhao S, Huang T, Ying H, Trujillo C, Molinaro G, Zhou Z, Jiang T, Liu W, Li L, Bai Y, Quan P, Ding Y, Hirvonen J, Yin G, Santos HA, Fan J, Liu D. Li W, et al. Nat Commun. 2022 Mar 10;13(1):1262. doi: 10.1038/s41467-022-28787-7. Nat Commun. 2022. PMID: 35273148 Free PMC article.