low birth weight infant (preterm infant)
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Introduction
Includes: preterm infants, also see preterm delivery
Monitor
Radiology
- avoid pneumograms for predischarge assessment of prolonged apnea of prematurity[9]
- avoid daily chest radiographs without indications for intubated infants
- avoid screening with term-equivalent or discharge brain MRIs in preterm babies[9]
Complications
- in-hospital mortality for infants born at 22-28 weeks of gestation = 26%
- very low birth weight infants (mean of 1179 g) vs normal infants (mean 3279 g) may sustain small, but persistent cognitive deficits, suggested by:
- lower IQ scores (87 vs 92)
- lower rate of graduation from high school (74% vs 83%)
- higher rate of neurosensory impairment (10% vs 1%)
- increased risk of hospitalization for psychiatric disease in young adulthood[2] (RR = 1.3-2.7)
- 42% of surviving premature infants (< 27 weeks gestation) have normal neurodevelopment at 2.5 years of age[4]
- 31-25% of infants born at 22-24 weeks gestation survive
- 52-57% without neurodevelopmental impairment[15]
- survival without neurodevelopmental impairment increased from 16% in 2000-2003 to 20% in 2008-2011[15] primarily due to an increase in survival; no change in the rate of survival with neurodevelopmental impairment[15]
- severe dermatitis in very preature infants
- prolonged elevations of plasma insulin (into adolescence)
- may be risk factor for development of insulin resistance & type 2 diabetes[6]
Management
- target SaO2 is 91-95%[11]
- kangaroo care in preterm infants (infant skin to maternal skin contact) is associated with better cognition, sleep, & executive function at 10 years of age[5]
- preterm infants breast fed during the 1st month of life have better school-age neurodevelopmental outcomes[13]
- supplemental enriched donor milk, compared to preterm infant formula is not associated with improved neurodevelopmental status at 18 months[14]
- active treatment in the NICU increases survival in infants 22-24 weeks of gestation but not at 25-26 weeks[8]
- avoid antireflux medications for treating symptomatic GERD or apnea & desaturation in preterm babies[9]
- avoid antibiotic therapy for > 48 hours to rule out bacterial infection in asymptomatic preterm infants[9]
- inhaled budesonide (200 ug/puff) within 24 hours of birth associated with less bronchopulmonary dsyplasia but similar or possibly higher mortality[10]
- recombinant human erythropoietin of uncertain benefit
- 500 U/kg every other day for the first 2 weeks reduces moderate/severe disability at 18 months[12]
- 3000 IU/kg as 3 IV doses administered at < 3, 12-18 & 36-42 hours of life does not improve 2-year neurodevelopmental outcomes[12]
More general terms
Additional terms
References
- ↑ Journal Watch 22(4):30, 2002 Hack M et al, Outcomes in young adulthood for very-low-birth-weight infants. N Engl J Med 346:149, 2002 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11796848
McCormick MC & Richardson DK Premature infants grow up. N Engl J Med 346:197, 2002 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11796855 - ↑ 2.0 2.1 Nosarti C et al Preterm Birth and Psychiatric Disorders in Young Adult LifePreterm Birth and Psychiatric Disorders Arch Gen Psychiatry. 2012;():610-617 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/22660967 <Internet> http://archpsyc.jamanetwork.com/article.aspx?articleID=1171951
- ↑ 3.0 3.1 Centers for Disease Control and Prevention Notes from the Field: Zinc Deficiency Dermatitis in Cholestatic Extremely Premature Infants After a Nationwide Shortage of Injectable Zinc - Washington, DC, December 2012 http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6207a5.htm
- ↑ 4.0 4.1 Serenius F et al. Neurodevelopmental outcome in extremely preterm infants at 2.5 years after active perinatal care in Sweden. JAMA 2013 May 1; 309:1810. PMID: https://www.ncbi.nlm.nih.gov/pubmed/23632725
- ↑ 5.0 5.1 Feldman R et al. Maternal-preterm skin-to-skin contact enhances child physiologic organization and cognitive control across the first 10 years of life. Biol Psychiatry 2013 Oct 3 http://www.biologicalpsychiatryjournal.com/article/S0006-3223(13)00764-6/abstract
Stein MT Skin-to-Skin Contact Between Mother and Preterm Baby Reduces Mortality. Physician's First Watch, Dec 22, 2015 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org
Boundy EO, Dastjerdi R, Spiegelman D et al Kangaroo Mother Care and Neonatal Outcomes: A Meta-analysis. Pediatrics. Jan 2016. EPub 2015 Dec 23 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26702029 <Internet> http://pediatrics.aappublications.org/content/early/2015/12/22/peds.2015-2238 - ↑ 6.0 6.1 Wang G et al. Preterm birth and random plasma insulin levels at birth and in early childhood. JAMA 2014 Feb 12; 311:587 PMID: https://www.ncbi.nlm.nih.gov/pubmed/24519298
- ↑ Patel RM et al. Causes and timing of death in extremely premature infants from 2000 to 2011. N Engl J Med 2015 Jan 22; 372:331 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25607427 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1403489
- ↑ 8.0 8.1 Rysavy MA et al. Between-hospital variation in treatment and outcomes in extremely preterm infants. N Engl J Med 2015 May 7; 372:1801 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25946279 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1410689
- ↑ 9.0 9.1 9.2 9.3 9.4 Ho T, Dukhovny D, Zupancic JA et al Choosing Wisely in Newborn Medicine: Five Opportunities to Increase Value. Pediatrics. July 20, 2015 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26195536 <Internet> http://pediatrics.aappublications.org/content/early/2015/07/15/peds.2015-0737
- ↑ 10.0 10.1 Bassler D et al. Early inhaled budesonide for the prevention of bronchopulmonary dysplasia. N Engl J Med 2015 Oct 15; 373:1497 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26465983 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1501917
Schmidt B. No end to uncertainty about inhaled glucocorticoids in preterm infants. N Engl J Med 2015 Oct 15; 373:1566. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26465990 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1501917 - ↑ 11.0 11.1 The BOOST-II Australia and United Kingdom Collaborative Groups. Outcomes of two trials of oxygen-saturation targets in preterm infants. N Engl J Med 2016 Feb 10 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/26863265 <Internet> http://www.nejm.org/doi/full/10.1056/NEJMoa1514212
- ↑ 12.0 12.1 12.2 Natalucci G et al Effect of Early Prophylactic High-Dose Recombinant Human Erythropoietin in Very Preterm Infants on Neurodevelopmental Outcome at 2 Years. A Randomized Clinical Trial. JAMA. 2016;315(19):2079-2085 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27187300 <Internet> http://jama.jamanetwork.com/article.aspx?articleid=2521968
Song J, Sun H, Xu F et al Recombinant Human Erythropoietin Improves Neurological Outcomes in Very Preterm Infants. Annals of Neurology. 2014 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27130143 <Internet> http://onlinelibrary.wiley.com/doi/10.1002/ana.24677/pdf - ↑ 13.0 13.1 Belfort, MB, Anderson PJ, Nowak VA et al Breast Milk Feeding, Brain Development, and Neurocognitive Outcomes: A 7-Year Longitudinal Study in Infants Born at Less Than 30 Weeks' Gestation. J Pediatr 2016. July 26. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27480198 <Internet> http://www.jpeds.com/article/S0022-3476(16)30411-5/pdf
- ↑ 14.0 14.1 O'Connor DL, Gibbins S, Kiss A et al Effect of Supplemental Donor Human Milk Compared With Preterm Formula on Neurodevelopment of Very Low-Birth-Weight Infants at 18 Months: A Randomized Clinical Trial. JAMA. 2016; 316(18):1897-1905 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27825008 <Internet> http://jamanetwork.com/journals/jama/fullarticle/2579868
Colaizy TT Donor Human Milk for Very Low-Birth-Weight Infants. JAMA. 2016;316(18):1875-1876 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/27824996 <Internet> http://jamanetwork.com/journals/jama/fullarticle/2579868 - ↑ 15.0 15.1 15.2 15.3 Younge N et al. Survival and neurodevelopmental outcomes among periviable infants. N Engl J Med 2017 Feb 16; 376:617 PMID: https://www.ncbi.nlm.nih.gov/pubmed/28199816
Shah PS. Neonatal intensive care - the only constant is change. N Engl J Med 2017 Feb 16; 376:694. PMID: https://www.ncbi.nlm.nih.gov/pubmed/28199815 - ↑ National Perinatal Association Multidisciplinary Guidelines for the Care of Late Preterm infants. http://www.nationalperinatal.org/lptguidelines/pdf/NPALatePretermGuidelines-11-12.pdf