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

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transition of the premature infant from hospital to home

Transition of the Premature Infant from Hospital to Home

Ma. Teresa C. Ambat, MD

Neonatology-TTUHSC

10/7/2008

introduction
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
late preterm
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
guidelines for pcp caring for late preterm infant
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
guidelines for pcp caring for late preterm infant7
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
guidelines for pcp caring for late preterm infant8
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
guidelines for pcp caring for late preterm infant9
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
guidelines for pcp caring for late preterm infant10
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
guidelines for pcp caring for premature infant
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
discharge planning
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
discharge planning16
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
potential medical problems for premature infants
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
potential medical problems for premature infants18
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