Anemia of Prematurity - Portal Neonatal

FOLLOW-UP CARE Section 5 of 7
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.