Table
From: Multidisciplinary guidelines for the care of late preterm infants
HEALTHCARE TEAM | FAMILY EDUCATION* | |
|---|---|---|
STABILITY | ||
• Monitor growth parameters (weight, length, and head circumference) at each well-child visit. • Consider need for fortification or supplementation of either breastmilk or formula if infant is failing to thrive per appropriate preterm growth curves. » Assess both volume of intake and also caloric density of feeds when planning fortification or supplementation. » Reassess at each visit to determine continued need for fortification or supplementation to maintain normal growth. » Encourage fortification/supplementation in ways that encourage suckling at the breast, if possible, such as higher calorie transitional formula given at separate feeds from breastfeeding. This is preferable to giving fortified expressed milk in a bottle at each feeding, which discourages feeding at the breast. • Recommend introducing solid foods no earlier than 6 months corrected gestational age (GA) and when infant demonstrates developmental readiness. | • Assess parents’ knowledge and reinforce importance of good nutrition. • Reinforce the health benefits of exclusive breastfeeding with appropriate fortification or supplementation if indicated, until 6 months of age. » Decreased incidence in gastrointestinal illnesses. » Possible delay in onset of eczema allergies. » No decrease in growth. • Provide verbal and printed information about appropriate introduction of healthy solid foods after 6 months of age. » Assess parents’ ability to choose and obtain healthy baby food. » Encourage continued breastfeeding until at least 1 year of age or longer in addition to solid foods. • Reinforce the importance of continuing to monitor growth. | |
• Assess parents’ understanding of ways to reduce upper respiratory infections throughout the first few years after birth. • Ask about signs or symptoms of asthma. | • Reinforce increased LPI’s risk for asthma, respiratory infection and re-hospitalization during the first year after birth: » Respiratory syncytial virus (RSV) is the most common infectious etiology. » High morbidity is similar to that of extremely preterm infants if admitted to the PICU. • Review ways to avoid respiratory illness: » Keep immunizations current. » Avoid crowds and contact with sick people. » Careful and consistent handwashing. » Protect from secondhand smoke. » Breastfeed for as long as possible during the first year after birth or longer. » Maintain good nutrition on a long-term basis. » RSV prophylaxis as indicated. | |
SCREENING | ||
• Evaluate for sensory impairments, including hearing, sight, and sensory integration. • Follow-up brainstem auditory evoked response (BAER) results if referral had been made. • Monitor for syndrome of auditory neuropathy/auditory dyssynchrony (normal otoacoustic emission (OAE) with abnormal auditory brain response (ABR)). | • Provide education about increased risk for sensory impairments: » Hearing impairment or deafness. » Visual impairment or blindness. » Disorders of sensory integration. » Auditory and visual processing delay. • Stress importance of hearing or vision follow-up. » Review date, time, and location of follow-up appointments. • Stress importance of alerting primary care provider of any concerns about hearing, vision, or speech. | |
Developmental Screening References: 2,4 10,47,75,7785,106,109,110,111,112,113,114,115,116 | • Perform regular developmental screening using valid and reliable assessment tools, such as: » Modified Checklist for Autism in Toddlers (MCHAT). » American Academy of Pediatrics’ (AAP) Bright Futures, including Pediatric Symptom Checklist (ages 4 years and up). » Brief Infant Toddler Social Emotional Assessment (BITSEA), for age 12–36 months; parent can fill out in 7–10 min • See the AAP’s websites for more tools (www.medicalhomeinfo.org) and (www.aap.org/sections/dbpeds). • Make referrals as indicated. | • Teach about LPI’s increased risk for developmental delays: » Psychomotor delay. » Cerebral palsy. » Cognitive delay. » Delay in school readiness. » Increased need for special educational services. » Increased disability (74% of total disability associated with preterm birth). • Stress importance of developmental follow-up. » Review date, time, and location of follow-up appointments. |
• Ask parents about any signs of behavioral or emotional disturbances in toddler or child. • Assess family’s support system and coping abilities. • Make referrals as indicated. | • Educate about LPI’s increased risk for behavioral and emotional disturbances: » Attention disorders. » Hyperactivity. » Internalizing behaviors. » Autism. » Schizophrenia. • Stress importance of alerting primary care provider regarding abnormal behaviors. | |
• Review ingestion of illicit and prescription drugs or other substances during pregnancy and refer mother to drug or alcohol rehabilitation program, if indicated. • Review use of prescription or herbal medications or supplements of concern, if identified. • Review smoking history (present or past use). » Refer family members who smoke to smoking cessation program. » Encourage mothers who quit smoking during or just prior to pregnancy to avoid relapse (high risk during the postpartum period). • Screen for psychiatric illness or perinatal mood disorders (including postpartum depression and post-traumatic stress disorder). » Parents separated from the infant at birth (e.g., due to cesarean delivery or NICU admission) are at higher risk for perinatal mood disorders. » Mothers of infants born prematurely are at increased risk for mood disorders in the first 6 months postpartum (three times higher than mothers of term infants). » Make referrals for treatment if indicated. • Evaluate mother’s understanding of any referrals made. | • Provide referrals to smoking cessation, drug or alcohol treatment, psychiatric, or support services, if indicated. • Explain risks of secondhand smoke exposure. » Stress importance of providing a smoke-free environment for all infants and children, especially those born prematurely. » Secondhand smoke exposure is associated with apnea, Sudden Infant Death Syndrome (SIDS), behavior disorders, hyperactivity, oppositional defiant disorder, sleep abnormalities, and upper respiratory infections. • Explain risks and benefits of prescription and herbal medications and supplements, if indicated. » Where medications are indicated, encourage use of medications compatible with breastfeeding, if possible. Reference LactMed at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT. • Provide information about postpartum depression and post-traumatic stress disorder and encourage parents to seek help if needed. • Provide contact information for local professional and community resources as appropriate to provide assistance for parenting support, substance abuse, domestic violence, and mental health issues | |
SAFETY | ||
• Assess family risk factors and make referrals if needed: » Drug or alcohol use in home. » Smokers in home. » Domestic violence. » Mental health issues. » Social services involvement. • Evaluate parents’ understanding of any referrals made. | • Provide verbal and written information about where to get professional and community support. | |
Developmental Risk Factors | • Assess for fine and gross motor development and behaviors that may lead to potential safety risks. | • Review LPI’s increased risk for fine and gross motor development and behaviors that may lead to potential safety risks: » Hyperactivity. » Seizure disorder. |
SUPPORT | ||
Infant Support | • Assess and address specialized support needs and make referrals, if indicated: » Physical, occupational, or speech therapy. » Subspecialty care. » Early childhood intervention (0–3 years). » School disability programs (ages 3 years and up). • Use resources such as Child Find (free screenings, available in all states) to identify children who may need early intervention services (www.childfindidea.org). • Use resources such as the National Dissemination Center for Children with Disabilities (www.nichcy.org). | • Reinforce LPI’s increased risk for need of specialized support and resources. • Provide verbal and written information about how to find state and community resources. |
Family Support | • Assess adequacy of family’s support system. • Identify family’s support needs: » Parent support groups for specific disabilities. » State parent-to-parent groups or other parenting support groups. » State parent training and information • Ask parents if they have any questions or concerns that have not already been addressed. • Provide a call-back number for general questions that come up when family is home. | • Reinforce increased risk of need for specialized family support due to special needs of infants born prematurely. • Provide verbal and written information about how to find state and community resources for families of infants born prematurely. |
