Preterm Infant

Monitoring

Introduction
Preterm:
gestational age < 37 completed
weeks

incidence of low birth weight

leading underlying cause of infant

mortality among infants with
nonlethal congenital anomalies
(Maternal Nutrition and Birth Outcomes (2010) 32 (1): 5-25)

Morbidity of Preterm
Infants
Infection

IVH
PVL

Anemia of
Prematurity
higher rate of
hospital
readmission and
death during
the rst year after
birth
PDA

Chronic
lung
disease,
BPD

Sensory
Problems:
hearing loss,
ROP

Long-term Outcome
Neurodevelopment
Problems
Motoric delay
CP
Global delay MR
Speech & language
delay

Behavioral Problem
ADHD

Neurosensory
Problems
Hearing
impairment
Visual impairment

Learning disability
Subnormal
acadrmic
achievement

The problems increase with decreasing gestational

age

(Doyle LW, NeoReviews 2009)

NICU discharge criteria

Discharge planning
Parental counseling
Follow up

Follow-up of Preterm Infant

Promotion and prevention:
Parental counseling
Immunization
Growth monitoring
Identication and treatment of medical
complications
Neurologic assessment
Sensory, developmental and behavioural
assessment
(AAP, Committee on Fetus and Newborn. 2008)

Parental Counseling
Breastfeeding:
Breast milk protective factor for visual development,
intellectual development, brain growth and cognition
Increased epidermal and transforming growth factors (EGF
and TGF-alpha) in mother's milk during the rst postpartum
month healing eects on infants gastrointestinal mucosa.
Kanguru mother care
Massage therapy with moderate pressure promotes weight gain
signicantly, increase bone density, and shorter hospital stay

(Field T, et al, Infant Behav Dev. ; 2010)

Sleep hygiene
SIDS risk-reduction
Stimulation: child- primary care givers interaction

Sudden Infant Death Syndrome

(SIDS)
Preterm infants are at increased risk of SIDS
There is stronger association between prone
sleeping and SIDS in LBW infants than in normal
BW infants
Supervised, awake tummy time is recommended
to facilitate development and to minimize
development of positional plagiocephaly

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 not
advised.
Use a rm sleep surface
Room-sharing without bed- sharing
Keep soft objects and loose bedding out of the crib
Avoid smoke exposure during pregnancy and lactation
Breastfeeding is recommended
Avoid overheating
Infants should be immunized in accordance with
recommendations

Immunization
Preterm infants are at high risk for increased
morbidity from vaccine-preventable diseases, but
they are the group to most likely have delayed
immunizations
Except hepatitis B, vaccines should be given at
full dose and on schedule by chronological age to
the medically-stable preterm infant

(Satgas IDAI 2014, CDC 2015,

AAP 12)

Hepatitis B Vaccine in
Premature Infant
Preterm infants born to mother with HBsAg
positive or unknown must receive hepatitis B
vaccine and hepatitis B immune globulin (HBIG)
within 12 hours of birth
Infant with BW < 2.000 gram whose mother with
HBsAg negative: hep B vaccine should be
postponed at chronologic age 1 month or at
discharge if they are medically stable and have
gained weight consistently
(Pink book, CDC 2015, satgas IDAI 2014)

Saari TS. 2003. Immunization of preterm and low birth weight infants. Pediatrics. 2003;112:193198.

Growth Monitoring
Early indentication of health and nutrition
problem early intervention
Adequate growth in early life decrease the risk of
CP and neurodevelopment problems
(Richard. Pediatrics; 2006)

Head circumference (HC) growth correlate with

MRI and neurodevelopment outcome
(Cheong JL. Pediatrics; 2008)

Growth Asessment
Weight, length, and head circumferences should be
collected routinely and serially in all programs using
standard techniques.
plot precisely, interpreting the growth
Child < 2 years:
weight should be obtained with the child completely
undressed
length is obtained by using a pediatric length board,
Maximal occipital frontal head circumference is recorded
to the nearest millimeter by using a non stretch
measuring tape

(British Columbia, WHO growth standard training module, 2014)

Corrected Age for Premature

Infants
Corrected postnatal age is based on 40 weeks
gestation and used until 24 months postnatal age
Corrected age = Current postnatal age - (40 age
at birth)
Eg at 14 weeks postnatal age, an infant born at
30 weeks gestational age would be 4 weeks
corrected postnatal age: (14- (40-30))= 4 weeks
corrected age
(British Columbia, WHO growth standard training module, 2014)

Growth Chart for Preterm

Infant
Equivalent to the WHO growth charts at 50 weeks
gestational age (10 weeks post term age)
> 10 weeks old: use WHO growth standard 2006
Girl and boy specic charts
Should be plotted as exact ages: eg a baby at 25
3/7 weeks should be plotted along the x axis
between 25 and 26 weeks.
(Fenton TR; BMC Pediatrics 2013)

Fenton
Chart

Poor Growth
Poor feeding skill:
Sucking reflex
Sensory problems/ feeding aversion
Inadequate intake:
Breast milk Fortication with human milk fortier
Formula milk: preterm formula, post discharge
formula, standard formula
Increase metabolism:
Cardiac problems, respiratory

Hearing
Premature baby should undergo hearing
examinations prior to discharge or 1 month
corrected age (if not by discharge)
Repeat at 6 months old
Other risk factors: meningitis, asphyxia, exchange
transfusions, and administration of ototoxic
drugs, such as gentamicin

Vision
Regular, long-term ophthalmologic follow-up,
including eye examination at one and ve
years of age is recommended for all ELBW
infants regardless of presence or absence of ROP

Vision
Screening of ROP:
At chronologic age 4 weeks (or at 31 weeks' post
conceptual age if the infant was born before 27
weeks' gestation) and, depending on the results, at
least every 2 weeks thereafter until the retina is
fully vascularized or ROP regresses
Screening for myopia, strabismus, and amblyopia,
nystagmus
(AAP section on Ophthalmology/ American Academy of Ophthalmology (AAO)/
American Association of Pediatric Ophthalmology and Strabismus (AAPOS),
2013)

Neurologic Examination
Observation of posture, movement,
and quality of movement before the
onset of the formal examination
Primitive reflex
Postural tone: ventral suspension,
trunchal positioning
Symmetrical posture
(Neuromotor screening expert panel, AAP, Pediatrics
2013)

Development and Behavioral

Monitoring
Developmental surveillance at every visit
Developmental screening if developmental
surveillance concerned, 9 month, 18 months,
24/30 months and 48 months of ages

Development Screening
Tools
Pre-screening development questionnaires KPSP
(every 3 months, then every 6 months after 2
years of age)
Parents evaluation on development status (PEDS)
Denver II
BINS ( Bayley Infant Neurodevelopment Screener)
Capute Scale (CAT CLAMS)
Pediatric symptom checklist (PSC)
Strength & diculty questionnaire (SDQ)
Abbreviated Conners rating scale (Hyperactivity)
Checklist for Autism in Toddlers ( CHAT)/ M-CHAT

Terima Kasih