Premature newborn care

Morbidity and mortality for all complications of prematurity are inversely proportional to gestational age.[115]Patel RM. Short- and long-term outcomes for extremely preterm infants. Am J Perinatol. 2016 Feb;33(3):318-28. http://www.ncbi.nlm.nih.gov/pubmed/26799967?tool=bestpractice.com ​ Although the overall incidence of premature birth is <15%, it accounts for close to 70% of infant mortality. Morbidity of prematurity is most pronounced in extremely premature infants.

Most infants require hospitalisation until 35 to 36 weeks' post-menstrual age to reach appropriate milestones prior to discharge. These include maintenance of normothermia outside of an isolette, adequate oral intake, demonstration of adequate growth/weight gain, and absence of apnoea or bradycardia. Parents must demonstrate comfort in caring for their infant and addressing specific issues.[116]Moster D, Lie RT, Markestad T. Long-term medical and social consequences of preterm birth. N Engl J Med. 2008 Jul 17;359(3):262-73. https://www.nejm.org/doi/full/10.1056/NEJMoa0706475 http://www.ncbi.nlm.nih.gov/pubmed/18635431?tool=bestpractice.com [117]Anderson N, Narvey M. Discharge planning of the preterm infant. Paediatr Child Health. 2022 Mar 4;27(2):129-30. https://cps.ca/en/documents/position/discharge-planning-of-the-preterm-infant ​ Very and moderately preterm children had a higher risk of being prescribed/dispensed cardiovascular medication, anti-seizure medication, anti-asthmatic medication and antibiotics in the first 10 years of life compared with term children, in a population-based data linkage cohort study across six European regions.[118]Damkjaer M, Loane M, Urhøj SK, et al. Preterm birth and prescriptions for cardiovascular, antiseizure, antibiotics and antiasthmatic medication in children up to 10 years of age: a population-based data linkage cohort study across six European regions. BMJ Open. 2022 Oct 17;12(10):e061746. https://bmjopen.bmj.com/content/12/10/e061746.long http://www.ncbi.nlm.nih.gov/pubmed/36253045?tool=bestpractice.com

Extreme prematurity: gestational age <28 weeks

This group suffers the greatest mortality and complications of prematurity, which include bronchopulmonary dysplasia (BPD), white matter injury (WMI) and neurodevelopmental impairment (NDI), necrotising enterocolitis (NEC), intraventricular haemorrhage (IVH), patent ductus arteriosus (PDA), sepsis, pneumonia, retinopathy of prematurity (ROP), and behavioural/motor/cognitive problems such as ADHD, poor motor skills, and lower IQ scores.

Hospital courses are very prolonged, and parents often require significant support during periods of critical illness.

Severe prematurity: gestational age 28 to 31 weeks

Mortality is significantly lower than that seen in extremely premature infants. Overall morbidity is also less significant, although severe IVH, WMI and NDI, and behavioural/motor/cognitive problems occur. Sepsis, NEC, PDA, and ROP are also present in some infants. Long-term outcome is related to the extent of the pathology in each infant.

Moderate prematurity: gestational age 32 to 33 weeks

This group of infants is less often affected by respiratory distress syndrome (RDS), IVH, or ROP. However, problems of sepsis, PDA, and NDI may be present and should be managed as appropriate. Nutritional deficiency and faltering growth should be managed with adequate caloric intake and follow-up of growth.

Late-preterm: gestational age 34 to 36 weeks

These infants rarely suffer the severe debilitating complications seen with prematurity (e.g., PDA, RDS, IVH, ROP, periventricular leukomalacia, NEC). However, although often treated the same as 'term' infants, they may experience significant difficulties with feeding and hospital re-admission for dehydration, jaundice, and sepsis. Long-term cognitive and behavioural deficits are comparable with term infants.