Outpatient Care of the Premature Infant

Michael Bybel; Catherine A. Delaney; Katie Coble

MICHAEL BYBEL, DO, CATHERINE A. DELANEY, MD, AND KATIE COBLE, MD

This is a corrected version of the article that appeared in print.

Am Fam Physician. 2025;112(2):153-161

This clinical content conforms to AAFP criteria for CME.

Author disclosure: No relevant financial relationships.

Family physicians oversee the complex care of premature infants after discharge from the neonatal intensive care unit, taking into consideration the degree of prematurity and unique complications that can occur. Early family engagement is critical for these infants. Before hospital discharge, at least two caregivers should demonstrate the ability to appropriately feed and provide necessary care for the infant. Premature infants are at risk of hypoxic-ischemic encephalopathy, periventricular leukomalacia, retinopathy of prematurity, bronchopulmonary dysplasia, necrotizing enterocolitis, and intraventricular hemorrhage. Routine vaccination is recommended. This includes newer prevention options for respiratory syncytial virus (eg, nirsevimab [Beyfortus]) and the prenatal vaccine Abrysvo. Growth of premature infants is monitored using corrected age and may improve with use of breast milk fortifiers or enriched formulas. Premature infants are also at risk for neurodevelopmental disabilities, including cerebral palsy, intellectual disability, and vision and hearing impairment. Developmental screening using corrected age is recommended at ages 9, 18, and 30 months, with screening for autism spectrum disorder at 18 and 24 months.

In 2023, approximately 10% of all births in the United States were preterm (occurring at less than 37 weeks’ gestation).¹ Such births can be further classified as late preterm (34 to 36 6/7 weeks), moderately preterm (32 to 33 6/7 weeks), very preterm (28 to 31 6/7 weeks), and extremely preterm (less than 28 weeks).^1,2 [corrected] These and other common terms related to the care of premature infants are defined in Table 1.^2,3 Various medical and neurodevelopmental morbidities are possible across the spectrum of prematurity, which may profoundly affect the newborn and family.

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