ELBW INFANTS FOLLOW-UP CARE
Category: Child Health
Abstract : elbw infants follow-up care Nearly all ELBW infants require
neurodevelopmental follow-up monitoring to track their progress and to identify
disorders that were not apparent during the hospital stay. These infants
typically have complicated medical courses and often go home with multiple
treatments and medications. In addition to monitoring their immediate medical
needs upon discharge,
elbw infants follow-up care
Nearly all ELBW infants require
neurodevelopmental follow-up monitoring to track their progress and to identify
disorders that were not apparent during the hospital stay. These infants
typically have complicated medical courses and often go home with multiple
treatments and medications.
In addition to monitoring their immediate medical
needs upon discharge, evaluation of cognitive development, vision and hearing
ability, and neurodevelopmental progress is important.
As many as 48% of
ELBW infants have some type of major neurosensory or neurodevelopmental
impairment. Infants with grade III or IV IVH or infants with PVL (cysts in brain
parenchyma, typically seen on routine brain ultrasound images in infants aged
4-6 wk) are at the greatest risk for mental retardation. Other risk factors for
developmental disabilities include meningitis, asphyxia, delayed head growth,
and CLD.
Saigal et al investigated the long-term academic and social
outcomes of ELBW infants born from 1977-1982 in Ontario, Canada. ELBW infants
performed more poorly at psychometric testing at age 8 years and continued to do
so into their adolescence. When the birth weights were stratified, the cohort
with birth weights less than 750 g performed worse than the heavier ELBW cohort
(750-1000 g), but both groups still required more remedial resources than the
control group of term children. However, although this group of children were
reported by their parents to have more frequent and more complex limitations to
daily functioning, the children and their parents rated the quality of life of
the children to be fairly high.
Vision
Retinopathy of prematurity
(ROP) is a disease of a premature retina that has not yet fully vascularized.
Changes in oxygen exposure have been postulated to cause a disruption in the
natural course of vascularization and may result in abnormal growth of blood
vessels, which can result in retinal detachment and blindness. All infants with
birth weights less than 1000 g should undergo an eye examination by an
experienced pediatric ophthalmologist at age 4-6 weeks and, depending on the
results, at least every 2 weeks thereafter until the retina is fully
vascularized.
If ROP is present, its stage and location dictate
management, which can range from repeat examinations 1 week later to laser
surgery or cryotherapy. The presence of plus disease, or tortuosity of the
retinal vessels, is a poor prognostic sign and requires immediate treatment.
Infants with ROP are also at greater risk for sequelae, such as myopia,
strabismus, and amblyopia. ELBW infants without ROP should have a follow-up eye
examination at age 6 months.
Hearing
All infants should undergo
hearing examinations prior to discharge, using either evoked otoacoustic
emissions or brainstem auditory evoked potentials. ELBW infants are at higher
risk for hearing impairment because of their low birth weights. Other risk
factors include meningitis, asphyxia, exchange transfusions, and administration
of ototoxic drugs such as gentamicin. In addition, ELBW infants should undergo
repeat hearing examinations at age 6 months.
Other therapy
For
problems with cognitive and neurodevelopmental development, physical and
occupational therapy and early intervention development programs should be some
of the options available. Such programs should be coordinated with the infant's
pediatrician and with the follow-up care clinic. As an increasing number of
babies are born and continue to survive with birth weights less than 1000 g;
optimizing their chances for a healthy productive life is important.
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