Post-Discharge Follow-Up of Preterm Infants at High-Risk Neonatal Follow-Up Clinic of a Maternity Hospital

Abstract

Background: Recent advances in medical sciences have increased the survival of premature infants. Long-term follow-up is very important for decreasing the consequences of prematurity. Objectives: The present study aimed at investigating common post-discharge problems of premature neonates. Methods: In this prospective descriptive study, we selected preterm infants with a gestational age of < 34 weeks or birth weight of < 2,000 g referring to a high-risk neonatal follow-up clinic of Mahdieh Hospital from 2016 to 2017. Growth indices and other medical problems were evaluated. Results: Of 140 newborns, 51.4% were males. The mean gestational age and birth weight were 30 weeks and 1,366.99 g, respectively. The mean interval between the discharge and the referral time to the clinic was 6.16 days with a range of 1 to 45 days. The maximum number of visits of a patient to the clinic was 18 times. The first visit occurred at 2 - 3 days after the discharge and the oldest age of patients at outpatient visits was 36 months. Although the growth level of most patients at birth was in the 50th percentile of growth charts, the impairment of growth indices was detected after discharge, particularly in neonates with birth weights of < 1,000 g. The rate of exclusively breastfed infants was 17% while 83% were fed by the formula. Re-admission was observed in 26.4%. Infantile colic, gastroesophageal reflux, respiratory allergy, and hypothyroidism were observed in 25%, 22.1%, 3.6%, and 2.9% of the infants, respectively, and 6.6% needed surgical intervention. The rate of late anemia was 45.7%, with 26.4% requiring packed cell transfusion. Conclusions: Our study revealed that the rate of regular post-discharge follow-ups of preterm infants was low. Regarding growth impairments of preterm neonates, special attention to nutrition is recommended after discharge from the hospital. Given the low rate of exclusive breastfeeding of premature infants, comprehensive planning to raise the rate of feeding with breast milk is very important. Regarding the high rate of anemia and the need for packed cell transfusion, paying attention to good nutrition and iron supplementation is crucial after discharge.