Follow-up of Preterm Babies

7/25/2019 Follow-up of Preterm Babies

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Preterm InfantMonitoring


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IntroductionPreterm:gestational age < 37 completedweeks

incidence of low birth weight

leading underlying cause of infantmortality among infants withnonlethal congenital anomalies

(Maternal Nutrition and Birth Outcomes (2010) 32 (1): 5-25)


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Morbidity of Preterm

Infants

higher rate ofhospital

readmission anddeath during

the first year afterbirth

Infection

IVH

PVL

SensoryProblems:hearing loss,ROP

Chroniclungdisease,BPD

PDA

Anemia of

Prematurity


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Long-term OutcomeNeurodevelopmentProblems

Motoric delayCP

Global delayMR

Speech & languagedelay

Behavioral Problem

ADHD

NeurosensoryProblems

Hearingimpairment

Visual impairment

Learning disability

Subnormalacadrmicachievement

The problems increase with decreasing gestationalage

(Doyle LW, NeoReviews 2009)


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NICU discharge criteria

Discharge planning

Parental counseling

Follow up


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Follow-up of Preterm Infant Promotion and prevention:

Parental counseling

Immunization

Growth monitoring

Identification and treatment of medicalcomplications

Neurologic assessment

Sensory, developmental and behaviouralassessment

(AAP, Committee on Fetus and Newborn. 2008)


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Parental Counseling reastfeeding:

reast mil! protective factor for visual development,intellectual development, brain growth and cognition

Increased epidermal and transforming growth factors "#G$and %G$&alpha' in mother(s mil! during the first postpartummonth healing e)ects on infant*s gastrointestinal mucosa+

anguru mother care

-assage therapy with moderate pressure promotes weight gainsignificantly, increase bone density, and shorter hospital stay

(Field T, et al, Infant Bea! "e!. # 20$0)

Sleep hygiene

SI.S ris!&reduction

Stimulation: child& primary care givers interaction


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Sudden Infant Death Syndrome

(SIDS) Preterm infants are at increased ris! of SI.S

%here is stronger association between pronesleeping and SI.S in /0 infants than in normal0 infants

Supervised, awa!e tummy time is recommendedto facilitate development and to minimizedevelopment of positional plagiocephaly


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Prevention of SIDS Infants should be placed for sleep in a supine position

until 1 year of life, side sleeping is not safe and is notadvised+

2se a firm sleep surface

3oom&sharing without bed& sharing eep soft ob4ects and loose bedding out of the crib

5void smo!e e6posure during pregnancy and lactation

reastfeeding is recommended

5void overheating Infants should be immunized in accordance with

recommendations


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Immunization Preterm infants are at high ris! for increased

morbidity from vaccine&preventable diseases, butthey are the group to most li!ely have delayedimmunizations

#6cept hepatitis , vaccines should be given atfull dose and on schedule by chronological age tothe medically&stable preterm infant

"Satgas I.5I 891, ;.; 891


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Hepatitis B Vaccine inPremature Infant

Preterm infants born to mother with =s5gpositive or un!nown must receive hepatitis vaccine and hepatitis immune globulin "=IG'within 18 hours of birth

Infant with 0 > 8+999 gram whose mother with=s5g negative: hep vaccine should bepostponed at chronologic age 1 month or atdischarge if they are medically stable and have

gained weight consistently(Pin% boo%, C"C 20$&, sat'as I"AI 20$)


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Saari TS. 2003. Immunization of preterm and low birth weight infants.Pediatrics. 2003;112:193-198.


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Growth Monitoring #arly indentification of health and nutrition

problem ? early intervention

5de@uate growth in early life decrease the ris! of;P and neurodevelopment problems(i*ard. Pediatri*s# 200+)

=ead circumference "=;' growth correlate with-3I and neurodevelopment outcome(Ceon' -. Pediatri*s# 2008)


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Growth Asessment 0eight, length, and head circumferences should be

collected routinelyand seriallyin all programs usingstandard techniques.

AplotB precisely, interpreting the growth

;hild > 8 years: weight should be obtained with the child completely

undressed

length is obtained by using a pediatric length board,

-a6imal occipital frontal head circumference is recorded

to the nearest millimeter by using a non stretchmeasuring tape

(Britis Columbia, / 'rowt standard trainin' module, 20$)


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Corrected Age for PrematureInfants

;orrected postnatal age is based on 9 wee!sgestation and used until 8 months postnatal age

;orrected age C ;urrent postnatal age & "9 D ageat birth'

#g at 1 wee!s postnatal age, an infant born atE9 wee!s gestational age would be wee!scorrected postnatal age: "1& "9&E9''C wee!scorrected age

(Britis Columbia, / 'rowt standard trainin' module, 20$)


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G hCh f P


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Growth Chart for PretermInfant

#@uivalent to the 0=F growth charts at


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FentonChart


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Poor GrowthPoor feeding s!ill:

Suc!ing reKe6

3ensor4 5roblems6 feedin' a!ersion

Inade@uate inta!e:

reast mil! Forti7*ation with human mil! fortifier

$ormula mil!: preterm formula, post dischargeformula, standard formula

Increase metabolism:

;ardiac problems, respiratory


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Hearing Premature baby should undergo hearing

e6aminations prior to discharge or 1 monthcorrected age"if not by discharge'

3epeat at 6 months old

Fther ris! factors: meningitis, asphy6ia, e6changetransfusions, and administration of ototo6icdrugs, such as gentamicin


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Vision 3egular, long&term ophthalmologic follow&up,

including eye e6amination at one and fiveyears of ageis recommended for all #/0infants regardless of presence or absence of 3FP


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VisionScreening of 3FP:

5t chronologic age 4 weeks "or at E1 wee!s( postconceptual age if the infant was born before 8Jwee!s( gestation' and, depending on the results, at

least every 2 weeksthereafter until the retina isfully vascularized or 3FP regresses

Screening for myopia, strabismus, and amblyopia,

nystagmus

"55P section on Fphthalmology 5merican 5cademy of Fphthalmology "55F'5merican 5ssociation of Pediatric Fphthalmology and Strabismus "55PFS',891E'


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Neurologic Examination Fbservation of posture, movement,

and @uality of movement before theonset of the AformalB e6amination

Primitive reKe6

Postural tone: ventral suspension,trunchal positioning

Symmetrical posture

(Neuromotor s*reenin' e5ert 5anel, AAP, Pediatri*s20$)


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Development and BehavioralMonitoring

.evelopmental surveillance at every visit

.evelopmental screening if developmentalsurveillance concerned, L month, 1M months,8E9 months and M months of ages

D l tS i


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Development ScreeningTools

Pre&screening development @uestionnaires ? PSP"every E months, then every H months after 8years of age'

Parents* evaluation on development status "P#.S'

.enver II

INS " ayley Infant Neurodevelopment Screener'

;apute Scale ";5% D ;/5-S'

Pediatric symptom chec!list "PS;'

3tren't 9 di:*ult4 ;uestionnaire "S.'

Abbre!iated Conners ratin' s*ale"=yperactivity'

;hec!list for 5utism in %oddlers " ;=5%' -&;=5%


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Terima Kasih

Follow-up of Preterm Babies

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