Preterm infant care after hospital discharge

Primary follow-up care in a multidisciplinary setting enhances catch-up growth of very-low-birth-weight infants

OBJECTIVE

To determine the impact of multidisciplinary primary care follow-up, which included the services of a registered dietitian, on growth outcomes of very-low-birth-weight (VLBW) infants.

DESIGN

Data were obtained retrospectively from medical records. Forty-two infants receiving follow-up care on an as needed basis from the general pediatric clinic were compared with 33 infants receiving multidisciplinary follow-up care that included routine nutrition intervention from the comprehensive care clinic. Comparisons were made in weight, length, and head circumference measurements; growth rates; and catch-up growth (defined as > or = 5th percentile on growth charts of the National Center for Health Statistics attained by 12 months growth-corrected age).

SUBJECTS

VLBW infants (< or = 1,500 g at birth) were selected from both follow-up groups.

STATISTICAL ANALYSIS

Chi 2 Analysis compared the proportions of infants in each group who achieved catch-up growth. Unpaired t tests compared group means in weight, length, and head circumference measurements and growth rates.

RESULTS

The two groups differed significantly in the number of infants exhibiting catch-up growth for length and head circumference. At 8 months growth-corrected age, 7 (28%) of the general pediatric clinic infants were at the 5th percentile or greater for length compared with 21 (64%) of the comprehensive care clinic infants (P < .01); 15 (60%) of the general pediatric clinic group and 30 (91%) of the comprehensive care clinic group were at the 5th percentile or greater for head circumference (P < .05). At 12 months growth-corrected age, 12 (57%) of the general pediatric clinic infants and 26 (87%) of the comprehensive care clinic infants were at the 5th percentile or greater for length (P < .05); 11 (52%) of the general pediatric clinic infants and 27 (90%) of the comprehensive care clinic infants were at the 5th percentile or greater for head circumference (P < .05).

APPLICATIONS

Multidisciplinary primary care follow-up that includes the services of a registered dietitian for nutrition intervention can enhance the catch-up growth of VLBW infants through 12 months growth-corrected age.

Problems of preterm infants after discharge

Preterm infants often experience continuing health problems after discharge and have a higher rate of readmittance to the hospital during the first year. These infants also are at risk for neurodevelopmental problems, such as language, learning, and school difficulties. The continuing health and developmental problems of preterm infants creates stress for the family. Nurses caring for these infants in hospital settings must understand the problems for which preterm infants are at risk after discharge as a basis for appropriate discharge planning and teaching. A similar knowledge base will help nurses working in community settings in assessment and interventions with infants and their families after discharge.

Special needs of the newborn infant in fluid therapy

The preterm baby, although less able to tolerate high fluid and solute loads, has a remarkable ability to adapt to a rather broad range of environmental challenges, and thus renal function in the preterm infant should no longer be considered impaired. Lower rather than higher fluid administration is the current trend in neonatal care because it is safer and more physiologic. Although changes in body weight over time provide a good indicator of water balance, determination of plasma and urine electrolytes and tonicity are also essential in the monitoring of fluid therapy in preterm infants.