eMedicine Specialties > Pediatrics: Cardiac Disease and Critical Care Medicine > Neonatology

Prematurity: Follow-up

Author: Susan A Furdon, MS, RNC, NNP, Neonatal Clinical Nurse Specialist/Nurse Practitioner, Department of Pediatrics, Albany Medical Center
Coauthor(s): David A Clark, MD, Chairman, Professor, Department of Pediatrics, Albany Medical College
Contributor Information and Disclosures

Updated: Jun 19, 2009

Follow-up

Further Inpatient Care

  • Discharge criteria in cases of prematurity are as follows:
    • The parents and/or caregivers are capable. That is, they demonstrate an ability to meet the needs of the infant.
    • The patient's caloric intake is adequate for growth.
    • The patient has been weaned from supplemental heat.
    • Medical problems are defined and manageable at home.
    • No apnea or bradycardia is present.

Further Outpatient Care

  • Developmental assessment and intervention, as appropriate

Transfer

  • Primary transfer to a tertiary center
    • Transferring to a center that specializes in care of high-risk mothers and infants improves outcome because of the availability of resources and experience.
    • Transfer can help in addressing neonatal issues of intravenous support and oxygenation and/or mechanical ventilation. It also provides access to pediatric subspecialists.
  • Reverse transfer
    • Consider transport and/or insurance costs.
    • Transfer may permit the family to be near the patient and to establish a family support system.
    • Reverse transfer may extend good will to the referring hospital (and forge ties to the regional neonatal ICU [NICU]) and promote continuity with the referral physician for discharge.
    • This may improve the experience of local hospital staff.
    • This may help in decompressing the regional NICU.
    • Reverse transfer may aid in addressing social service concerns.

Prognosis

  • Mortality and morbidity are inversely proportional to gestational age and birth weight.
  • Infants with extremely low birth weight (ELBW) who are born at tertiary care centers have outcomes more favorable than those who are born at level I or II centers and then transferred.

Patient Education

  • Discharge teaching of the premature infant includes the following:
    • Basic infant care - Bathing, skin care, taking a temperature
    • Infant feeding - Feeding cues, support of breastfeeding
    • Infant safety - Use of car seats, avoiding exposure to a smoky environment
    • Back to sleep - Strategies to help preterm infants return to sleep
    • Illness prevention (handwashing, avoid crowds, prophylaxis against infection with respiratory syncytial virus (RSV) as indicated, immunization schedule
    • When to call healthcare provider - Poor feeding, signs of illness, change in behavior, respiratory distress
    • Specifics related to chronic conditions - For example, use of a nasal canula and home oxygen therapy

Miscellaneous

Medicolegal Pitfalls

  • The medical-legal risk in prematurity is primarily linked to adverse outcome, inappropriate expectations on the part of the family, and poor communication with the family.
  • The smallest and most immature infants are at greatest risk of mental retardation and motor delay or disability.
 


More on Prematurity

Overview: Prematurity
Differential Diagnoses & Workup: Prematurity
Treatment & Medication: Prematurity
Follow-up: Prematurity
Multimedia: Prematurity
References
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Further Reading

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Keywords

prematurity, preterm, immature, low birth weight, LBW, extremely low birth weight, ELBW, pneumonia, respiratory distress syndrome, acute respiratory distress syndrome, ARDS, bronchopulmonary dysplasia, periventricular hemorrhage, intraventricular hemorrhage, jaundice, pneumonia, respiratory failure, premature rupture of membranes, PPROM, periventricular leukomalacia, PVL, congenital heart disease, patent ductus arteriosus, hearing loss, multiple gestation, multiple births, maternal diabetes, maternal chorioamnionitis, intrauterine growth retardation, treatment, diagnosis

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Contributor Information and Disclosures

Author

Susan A Furdon, MS, RNC, NNP, Neonatal Clinical Nurse Specialist/Nurse Practitioner, Department of Pediatrics, Albany Medical Center
Susan A Furdon, MS, RNC, NNP is a member of the following medical societies: National Association of Neonatal Nurses and Sigma Theta Tau International
Disclosure: Nothing to disclose.

Coauthor(s)

David A Clark, MD, Chairman, Professor, Department of Pediatrics, Albany Medical College
David A Clark, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American Pediatric Society, Christian Medical & Dental Society, Medical Society of the State of New York, New York Academy of Sciences, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Medical Editor

Ted Rosenkrantz, MD, Professor, Departments of Pediatrics and Obstetrics/Gynecology, Division of Neonatal-Perinatal Medicine, University of Connecticut School of Medicine
Ted Rosenkrantz, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Pediatric Society, Connecticut State Medical Society, Eastern Society for Pediatric Research, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

Managing Editor

Arun K Pramanik, MD, MBBS, Professor of Pediatrics, Director of Neonatal Fellowship, Louisiana State University Health Sciences Center
Arun K Pramanik, MD, MBBS is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, National Perinatal Association, and Southern Society for Pediatric Research
Disclosure: Nothing to disclose.

CME Editor

Carol L Wagner, MD, Professor of Pediatrics, Medical University of South Carolina
Carol L Wagner, MD is a member of the following medical societies: American Academy of Pediatrics, American Chemical Society, American Medical Women's Association, American Public Health Association, American Society for Bone and Mineral Research, American Society for Clinical Nutrition, Massachusetts Medical Society, National Perinatal Association, and Society for Pediatric Research
Disclosure: Nothing to disclose.

Chief Editor

Ted Rosenkrantz, MD, Professor, Departments of Pediatrics and Obstetrics/Gynecology, Division of Neonatal-Perinatal Medicine, University of Connecticut School of Medicine
Ted Rosenkrantz, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Pediatric Society, Connecticut State Medical Society, Eastern Society for Pediatric Research, and Society for Pediatric Research
Disclosure: Nothing to disclose.

 
 
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