DISCHARGE & FOLLOW-UP OF THE PREMATURE INFANT
Saturday, August 16, 2008
Hospital Discharge
Medical criteria for discharge of the premature infant includes the ability to maintain temperature in an open crib, nippling all feeds and gaining weight, and the absence of apneic and bradycardiac spells requiring intervention. Infants going home on supplemental oxygen should not desaturate too badly (< 80%) in room air or should demonstrate the ability to arouse in response to hypoxia. Factors such as support for the mother at home and the stability of the family situation play a role in the timing of discharge. Home nursing visits and early physician follow-up can be utilized to hasten discharge.
Follow-Up
With advances in obstetric and maternal care, survival for infants born at less than 28 weeks’ gestation or with birth weights as low as 1000 g is now better than 90%. Eighty percent or more survive at 26–27 weeks’ gestation and birth weights of 800–1000 g. Survival at gestational age 25 weeks and birth weight 700–800 g is nearly 70%, with a considerable drop-off below this level .
These high rates of survival do come with a price in terms of morbidity. Major neurologic sequelae, including cerebral palsy, cognitive delay, and hydrocephalus, is reported in 10–25% of survivors with birth weights under 1500 g. The rate of these sequelae tends to be higher in infants with lower birth weights. In addition to a higher incidence of severe neurologic sequelae, infants with birth weights under 1000 g have an increased rate of lesser disabilities, including learning and behavioral problems. Risk factors for neurologic sequelae include seizures, grade III or IV intracranial hemorrhage, periventricular leukomalacia, severe intrauterine growth restriction, poor early head growth, need for mechanical ventilation, and low socioeconomic class. In addition, maternal fever and chorioamnionitis have been associated with an increased risk of cerebral palsy. Other morbidities in these infants include chronic lung disease and reactive airway disease, resulting in an increased risk from respiratory infections and hospital readmissions in the first 2 years, retinopathy of prematurity, hearing loss, and growth failure. All of these issues require close multidisciplinary outpatient follow-up. Infants with residual lung disease are candidates for monthly palivizumab (Synagis) injections during their first winter after hospital discharge to prevent severe infection with respiratory syncytial virus.
Medical criteria for discharge of the premature infant includes the ability to maintain temperature in an open crib, nippling all feeds and gaining weight, and the absence of apneic and bradycardiac spells requiring intervention. Infants going home on supplemental oxygen should not desaturate too badly (< 80%) in room air or should demonstrate the ability to arouse in response to hypoxia. Factors such as support for the mother at home and the stability of the family situation play a role in the timing of discharge. Home nursing visits and early physician follow-up can be utilized to hasten discharge.
Follow-Up
With advances in obstetric and maternal care, survival for infants born at less than 28 weeks’ gestation or with birth weights as low as 1000 g is now better than 90%. Eighty percent or more survive at 26–27 weeks’ gestation and birth weights of 800–1000 g. Survival at gestational age 25 weeks and birth weight 700–800 g is nearly 70%, with a considerable drop-off below this level .
These high rates of survival do come with a price in terms of morbidity. Major neurologic sequelae, including cerebral palsy, cognitive delay, and hydrocephalus, is reported in 10–25% of survivors with birth weights under 1500 g. The rate of these sequelae tends to be higher in infants with lower birth weights. In addition to a higher incidence of severe neurologic sequelae, infants with birth weights under 1000 g have an increased rate of lesser disabilities, including learning and behavioral problems. Risk factors for neurologic sequelae include seizures, grade III or IV intracranial hemorrhage, periventricular leukomalacia, severe intrauterine growth restriction, poor early head growth, need for mechanical ventilation, and low socioeconomic class. In addition, maternal fever and chorioamnionitis have been associated with an increased risk of cerebral palsy. Other morbidities in these infants include chronic lung disease and reactive airway disease, resulting in an increased risk from respiratory infections and hospital readmissions in the first 2 years, retinopathy of prematurity, hearing loss, and growth failure. All of these issues require close multidisciplinary outpatient follow-up. Infants with residual lung disease are candidates for monthly palivizumab (Synagis) injections during their first winter after hospital discharge to prevent severe infection with respiratory syncytial virus.
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