Common Questions About Outpatient Care of Premature Infants



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Am Fam Physician. 2014 Aug 15;90(4):244-251.

This clinical content conforms to AAFP criteria for continuing medical education (CME). See the CME Quiz Questions.

  Patient Information: A handout on this topic is available at http://familydoctor.org/familydoctor/en/pregnancy-newborns/caring-for-newborns/infant-care/caring-for-your-premature-baby.html.

Author disclosure: No relevant financial affiliations.

Preterm births (deliveries before 37 weeks' gestation) comprise 12% of all U.S. births and are responsible for one-third of all infant deaths. Neonatal medical advances have increased survival, and primary care physicians often care for infants who were in the neonatal intensive care unit after birth. Functions of the primary care physician include coordination of medical and social services, nutritional surveillance, and managing conditions associated with prematurity. Parental guidance and encouragement are often necessary to ensure appropriate feeding and infant weight gain. Enriched formula and nutrient fortifiers are used for infants with extrauterine growth restriction. Iron supplementation is recommended for breastfed infants, and iron-fortified formula for formula-fed infants. Screening for iron deficiency anemia in preterm infants should occur at four months of age and at nine to 12 months of age. Gastroesophageal reflux is best treated with nonpharmacologic options because medications provide no long-term benefits. Neurodevelopmental delay occurs in up to 50% of preterm infants. Developmental screening should be performed at every well-child visit. If developmental delay is suspected, more formalized testing may be required with appropriate referral. To prevent complications from respiratory syncytial virus infection, palivizumab is recommended in the first year of life during the respiratory syncytial virus season for all infants born before 29 weeks' gestation and for infants born between 29 and 32 weeks' gestation who have chronic lung disease. Most preterm infants have minimal long-term sequelae.

Preterm birth (delivery before 37 weeks' gestation) comprises 12% of all deliveries and accounts for one-third of all infant deaths.1,2  Because advances in neonatal medical care have increased the survival of preterm infants, primary care physicians are taking a more active role in the care of these infants after they are released from the neonatal intensive care unit (e.g., coordinating medical and social services, nutritional surveillance, managing conditions associated with prematurity, and parental guidance and encouragement). Common terminology used in the care of premature infants is listed in Table 1,3  and a summary schedule for well visits is provided in Table 2.4,5 This article reviews common questions encountered in managing care of premature infants.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation Evidence rating References

Nutrient fortification of breast milk or enriched formula should be considered in premature infants who are less than the 10th percentile in weight for corrected age.

C

20, 25, 29, 30, 36

Standardized screening should be used in premature infants at nine, 18, and 24 to 30 months of age to detect neurodevelopmental delay.

C

4345, 49

Breastfed preterm infants should receive supplemental iron from one to 12 months of age or until complementary foods provide a sufficient amount of iron.

C

53, 54

Immunoprophylaxis with palivizumab (Synagis) is recommended in the first year of life during the respiratory syncytial virus season for all infants born before 29 weeks' gestation to decrease the risk of hospitalization.

B

55, 56, 58


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

View Table

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendation Evidence rating References

Nutrient fortification of breast milk or enriched formula should be considered in premature infants who are less than the 10th percentile in weight for corrected age.

C

20, 25, 29, 30, 36

Standardized screening should be used in premature infants at nine, 18, and 24 to 30 months of age to detect neurodevelopmental delay.

C

4345, 49

Breastfed preterm infants should receive supplemental iron from one to 12 months of age or until complementary foods provide a sufficient amount of iron.

C

53, 54

Immunoprophylaxis with palivizumab (Synagis) is recommended in the first year of life during the respiratory syncytial virus season for all infants born before 29 weeks' gestation to decrease the risk of hospitalization.

B

55, 56, 58


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

Table 1.

Terms Commonly Used in the Care of Premature Infants

Term Definition

Prematurity (based on gestational age)

Early term

37 to < 39 weeks

Late preterm

34 to < 37 weeks

Very premature

The Authors

ROBERT L. GAUER, MD, is an assistant professor of family medicine at the Uniformed Services University of the Health Sciences, Bethesda, Md. He is a hospitalist at Womack Army Medical Center, Fort Bragg, N.C.

JEFFREY BURKET, MD, is a staff physician at General Leonard Wood Army Community Hospital, Fort Leonard Wood, Mo. At the time this article was written, he was a resident at the Womack Army Medical Center Family Medicine Residency.

ERIC HOROWITZ, MD, is a neonatologist in the Division of Neonatology at Duke University Medical Center, Durham, N.C. At the time this article was written, he was an assistant professor of pediatrics at the Uniformed Services University of the Health Sciences.

Address correspondence to Robert L. Gauer, MD, Womack Army Medical Center, Bldg. 4, 2817 Riley Rd., Fort Bragg, NC 28310 (e-mail: robert.l.gauer2.civ@mail.mil). Reprints are not available from the authors.

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