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Outpatient Care of Premature Infants | Part 1

Christine Mirzaian, MD, MPH, Solomon Behar, MD, and Liza Green Golan Mackintosh, MD
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Christine, Sol, and Liza discuss the special medical needs for infants born prematurely, including how to track an infant’s neurodevelopment accounting for their corrected gestational age, the risk and need for follow up for retinopathy of prematurity, which premature infants qualify for palivizumab, and how long to keep a premature infant on fortified formula.

 
  • A baby born before 37 weeks of pregnancy is called premature. Babies born before 28 completed weeks of pregnancy are considered extremely preterm. 

  • Corrected age is calculated by subtracting the number of weeks premature a baby is from his or her chronological age. Up until age two, corrected age should be used to assess the child’s development and growth. Chronological age should be used for vaccination.

    • The NICHD Neonatal Research Network has a corrected gestational age calculator found here.

  • The Fenton chart is the preferred growth chart to assess growth in preterm infants up until 52 weeks. 

  • The risk of neurodevelopmental impairment and behavior and psychological problems increases with decreasing gestational age. Prompt referral to Early Intervention programs is important.

  • Retinopathy of prematurity (ROP) is a vascular proliferative disorder that occurs in the retina of preterm infants with incomplete retinal vascularization. 

    • Screening for ROP should be done in infants with birth weight (BW) ≤1500 g or gestational age (GA) ≤30 weeks, as well as those  GA >30 weeks whose clinical course places them at increased risk for ROP. 

    • The general Pediatrician should ensure that a premature baby has timely follow-up with the Ophthalmologist not only to monitor for ROP but also to assess for reduced visual acuity, strabismus, myopia, amblyopia, and astigmatism.

  • Premature infants are at risk of sensorineural hearing loss. Because hearing deficits may present later, a second diagnostic audiology assessment by 24 to 30 months of age in infants with risk factors for hearing loss is recommended by the Joint Committee on Infant Hearing.

  • In the first year of life  palivizumab,for prevention of RSV,  is recommended for:

    • Infants born before 29 weeks, 0 days  gestation.

    • Preterm infants with CLD of prematurity, defined as birth at <32 weeks, 0 days gestation and a requirement for >21% oxygen for at least 28 days after birth.

    • Certain infants with hemodynamically significant heart disease.

    • Palivizumab prophylaxis is not recommended in the second year of life except for children who required at least 28 days of supplemental oxygen after birth and who continue to require medical intervention (supplemental oxygen, chronic corticosteroid, or diuretic therapy).

  • If any infant or young child receiving monthly palivizumab prophylaxis gets RSV, monthly prophylaxis should be discontinued.

  • Post-discharge preterm formula has increased caloric density, calcium, phosphorus, vitamin D and iron in comparison to term formulas. There is no consensus as to how long a baby should be maintained on enriched (22 kcal) formula but some say that extremely preterm babies should be on it until they are 12 months corrected age.  

    • Most preterm infants need 2 to 4 mg/kg/day of iron supplementation. If the infant is receiving post-discharge preterm formula, they may not need additional iron.

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You Say Tera-tomah-ta, I Say Tera-Tomay-to Full episode audio for MD edition 186:08 min - 87 MB - M4AHippo Peds RAP July 2019 Written Summary 296 KB - PDF

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