Transition of the Premature Infant from Hospital to Home

1. Transition of the Premature Infant from Hospital to Home Ma. Teresa C. Ambat, MD Neonatology-TTUHSC 10/7/2008

2. Introduction • PCPs are taking care of a growing population of former premature infants • PCPs should understand the special difficulties facing these infants and their families • PCPs should understand how to follow problems identified in the NICU and be attentive to new issues that may develop

3. Terms Commonly Used to Describe Premature Infants

4. Terms Commonly Used to Describe Premature Infants 36wks 9 months

5. Late Preterm • Potential short term morbidities: respiratory distress, jaundice, feeding difficulties, hypoglycemia, temperature instability and sepsis • Higher rate of rehospitalization within the first 2 weeks after discharge

6. Guidelines for PCP Caring for Late Preterm Infant • Newborn nursery care • Monitor for feeding difficulties, respiratory distress, jaundice, temperature instability, hypoglycemia and sepsis • Lower threshold for supplementing breastfeeding and obtaining lactation consultant who can continue to advise the mother after discharge • Car seat safety screening • Determine need for RSV prophylaxis • Educate family about differences between late preterm and full term

7. Guidelines for PCP Caring for Late Preterm Infant Family education • Feeding • Usually eat less and may need to be fed more often • Difficulty coordinating sucking, swallowing, and breathing during the feeding needs to be observed closely while eating • May feed well initially at the hospital  become tired and feed poorly contact PCP if the infant has decreased oral intake • 5-6 wet diapers in every 24 hour period

8. Guidelines for PCP Caring for Late Preterm Infant Family education • Sleeping • Sleepier than full term and sleep through feedings  should awaken the infant to feed • Should sleep on their backs • Thermoregulation • Difficulty regulating body temperature (decreased subq fat) • Should wear hats to decrease heat loss, if environmental temperature is cool • Jaundice • Greater risk for jaundice. Families should be taught how to look for jaundice and need for close-ffup

9. Guidelines for PCP Caring for Late Preterm Infant Family education • Infection • Greater risk for infections  watch for signs of infection (fever, difficulty breathing, lethargy) • Minimize exposure to crowded places • Practice good handwashing • Car safety seat • Minimize time in car seats until good head control is achieved

10. Guidelines for PCP Caring for Late Preterm Infant Follow up • Schedule appointments in 1-2 days after discharge • At first visit, PCP should: • Assess dehydration with weight check and P.E. • Evaluate for jaundice • Arrange for continued ff-up • Reemphasize educational points • Record results of the newborn screening

11. Guidelines for PCP Caring for Premature Infant • Manage complications of prematurity • Monitor for potential new problems • Support the family • Coordinate various medical and social services needed • Determine whether an Infant follow up program is needed • Refer infant to an early intervention program as needed (in most states NICU graduates are eligible for this program) • Educate the family by providing anticipatory guidance and a list of resources

12. Discharge Criteria

13. Discharge Teaching

14. Discharge Checklist

15. Discharge Planning • Follow-up appointments/referrals • Arrange discharge appointments at times that would decrease exposure to children with infections • PCP • Early childhood intervention (ECI) • Visiting nurse • Ophthalmologist • High-risk clinic • Other consultants

16. Discharge Planning • Discharge paper works to families • Supply the family with a copy of infants’ discharge summary • Discharge summary (recent weight, length, HC) • Immunization record • Growth curve • List of medications and doses • Appointments and contact numbers of consultants, including lactation consultant

17. Potential Medical Problems for Premature Infants • Respiratory • BPD, ventilator dependent with need for tracheostomy tube, apnea of prematurity • Growth and Nutrition • Inadequate nutrition and growth, difficulty with breastfeeding, nutritional deficiencies, complications of IUGR • GI • GER, colic, oral aversion, constipation, need for enteral tubes, NEC, SBS, direct hyperbilirubinemia

18. Potential Medical Problems for Premature Infants • Neurologic • IVH, post hemorrhagic HCP, white matter injury, CP, delayed neurodevelopment • Hematologic • Anemia of prematurity, indirect hyperbilirubinemia • Endocrine • Hypothyroidism, osteopenia • Neurosensory • ROP, other ophthalmologic issues, hearing loss • Surgical • Cryptorchidism, inguinal or umbilical hernia