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When monitoring growth and development in the premature infant, physicians should make adjustments for the estimated due date. With minor exceptions, administration of immunizations is based on the chronologic age. Administration of hepatitis B vaccine should be delayed until the infant weighs 2,000 g (4 lb, 5 oz). Administration of influenza vaccine should be considered in infants with chronic medical problems, and the pneumococcal vaccine may be beneficial at age two in children with chronic problems, especially pulmonary disease. Premature infants should also be monitored to assure appropriate nutrition. Breast-fed infants should probably receive vitamin supplements during the first year. Supplemental iron should be initiated at two weeks to two months after birth and continued for 12 to 15 months. Office care includes screening for problems that occur more frequently in premature infants, especially vision and hearing problems. Because many of these infants require care from multiple medical disciplines, coordination of care is another important role for the family physician. The goals of this care are to promote normal growth and development and minimize morbidity and mortality.
This is the first of a two-part article on office care of the premature infant Part II, on common medical and surgical problems, will appear in the next issue of American Family Physician.
Infants who are born before 37 weeks of gestational age are defined as premature (Table 1). These infants usually weigh less than 2,500 g (5 lb, 8 oz) and constitute about 10 percent of all births.I Infant mortality rises from five times normal at 37 weeks of gestational age to 45 times normal at 32 weeks of gestational age.2 Most of the problems associated with prematurity occur in infants with birth weights of 1,500 g (3 lb, 5 oz) or less, usually in those born at less than 32 weeks of gestational age.
Survival has increased significantly in extremely premature infants. For example, at Washington University, St. Louis, the survival rate of infants weighing less than 800 g (1 lb, 12 oz) at birth increased from 20 percent in 1977 to 49 percent in 1990.3 Because of the increased survival rate, and because many neonatal intensive care units now allow early discharge, family physicians are increasingly likely to provide care to small...