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Stony Brook Children’s Pediatric Primary Care Clinic Curriculum

Follow up care of preterm infant

May 2016

Materials developed by Loren Murphy, MD and Susan Walker, MD, FAAP

Appreciation to Dr. Shanthy Sridhar for assistance with article selection

Goal:

Plan the follow-up care of a NICU graduate

Objectives:

Know the symptoms associated with bronchopulmonary dysplasia

State the indications for Synagis®

Know that preterm infants have greater requirements for protein, calcium, phosphorus, and zinc than term infants, and also require supplementation with vitamin D and iron

Know that preterm infants should gain between 20 and 30 grams per day

Know that preterm infants born at 28 weeks or earlier should remain on 22 Kcal/ounce formula until one year adjusted age, and all preterm infants should stay on formula (rather than cow’s milk) until one year past term

Know that preterm infants should receive vaccines according to their chronological age

ABP content specs:

Identify and plan prophylaxis for patients at high risk of morbidity and mortality from respiratory syncytial virus infection

Plan appropriate outpatient management of bronchopulmonary dysplasia

Plan the appropriate screening and clinical evaluation of retinopathy of prematurity

Readings:



NICU follow-up care



Synagis® guidelines

Case Discussion:

Neveah is a 10-week old patient you are seeing for her first well check after hospital discharge, in November. Neveah was a 28 week preterm infant who was discharged 3 days ago. Her birth weight was 1020 gm. In the NICU, she was treated for respiratory distress syndrome and required intubation for 3 weeks. She was weaned off oxygen to room air one week prior to discharge. She was also treated for apnea of prematurity was weaned off caffeine also one week prior to discharge. She had no episodes of apnea, bradycardia or desaturation prior to discharge. Because of her respiratory problems she was on TPN for several weeks, followed by a long period of OG feeds. However, prior to discharge, she was taking all of her feeds by mouth and was having consistent weight gain.

Neveah is followed by the pulmonary team for chronic lung disease. Her mother asks about the upcoming winter season and is concerned because she has a 4 year old in preschool. Does Neveah qualify for Synagis®? Which criteria does she meet?

The mother is familiar with childhood vaccines from her experiences with her older child. She asks when it is appropriate to vaccinate her baby. What do you tell her? The baby received the first Hep B at about 6 weeks of life.

The mother is aware of the increased risk of SIDS in premature infants and asks about the use of an apnea monitor. What guidance do you give her? What can you suggest the mother do to reduce the risk of SIDS?

You discuss feedings with the mother. She says that the baby is taking 3 ounces of a 22 calorie preterm formula every 2-3 hours. What are the benefits of preterm formula for the growing preemie? If the mother was feeding breast milk, what would you advise? What conditions does the patient have that may predispose her to poor feeding?

What other supplements does this infant require?

The mother asks about solid introduction and when it may be appropriate to initiate cereal or solid foods. What do you tell her?

Lastly, you and the mother discuss Neveah’s milestones. What milestones do you expect she has achieved? What anticipatory guidance can you give the mother as to what to expect in the coming months? What will you recommend if the mother has any concerns regarding Nevaeh’s development?

In addition to seeing you on a regular basis, what other referrals would you make?

When do you want to see her again?

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