Hepatitis B: To be given in the first month, then again one and five months
later; for infants with birth weight under 1500 grams, the series may be
started at the time of discharge.
DPT, Hib, and IPV: Given according to normal vaccination schedule.
Parental consent must be obtained for all vaccinations. All vaccinations
should be recorded in the chart and should be provided to the parents in
writing at the time of discharge.
Hearing Exams
Otacoustic Emission: A screening test for all patients
BAER: as follow-up for an abnormal OAE, or to give information about brainstem
function.
Infants need to be seen again at 6 and 12 months.
Results and the date of the next needed appointment should be provided
to the parents in written form at the time of discharge.
Ophthalmologic Exams (also see
Retinopathy of Prematurity)
First at 34 weeks of post-menstrual age of at 4-6 weeks of life as indicated
thereafter for all infants less than 30 weeks or 1.5 kg birth weight or
less than 35 weeks and exposed to oxygen.
Nearly all infants need to be seen again at 6-12 months of age even if
their retinae have matured.
A summary of the current status and next needed appointment should be given
to the parents at discharge.
Head Ultrasound
Once (at 7 days) or twice (1-3 days and 7 days) or more near birth as indicated
by the clinical situation. At least once in all infants less than
32 weeks EGA.
Once to twice monthly to monitor resolution/evolution and ventricular size
especially in infants with original IVH of Grade II or more. These
infants should have daily head circumference recorded at the bedside to
monitor for post-hemorrhagic hydrocephalus.
At 6-8 weeks of age for possible periventricular leukomalacia.
Growth Charts
Weight, height and head circumference are to be entered into the growth
charts weekly and discussed at nutrition rounds. Send a copy home
with the parents at discharge.
Vitamins and Iron
Polyvisol is 1 cc per day and is divided bid for infants less than 2 kg.
Iron can be given as polyvisol with iron or separately as fer-in-sol.
The dose is 6 mg/kg for deficiency and 4 mg/kg for maintenance. Ferinsol
comes as 2.5 mg/0.1 cc and is given bid for infants less than 2 kg.
Vitamin E is 25 IU q day. Maintenance vitamins and iron are started
in the second month of life unless otherwise indicated.
Transitional Nutrition
Many premature infants need additional calories after discharge.
Caloric densities greater than 20 per ounce can be achieved with human
milk fortifier, formula powder, or polycose in conjunction with breast
milk or formula. Neocare 22 is available at the grocery store and
other formulas are available by prearrangement through pharmacies.
