Care Of Preterm Infants Research Articles

Taking Care of Preterm Infants: Outpatient Considerations.

In recent decades, the number of pre-term infants born each year has been on the rise as mortality rates decline with improvements in technology and medical care. As a result, many preterm infants are successfully discharged from the neonatal intensive care unit (NICU). However, with prematurity comes the increased risk of ongoing health and development needs. Special attention must be given to certain chronic conditions by the outpatient provider, including growth and nutrition; gastroesophageal reflux; immunizations; vision and hearing impairments; chronic lung diseases, including bronchopulmonary dysplasia and pulmonary hypertension; and neurodevelopmental outcomes. This article will detail some of these topics to better inform the primary care provider of appropriate strategies to manage these chronic conditions and sequalae on NICU discharge. [Pediatr Ann. 2023;52(6):e200-e205.].

Kangaroo mother care for preterm or low birth weight infants: a systematic review and meta-analysis

ImportanceThe Cochrane review (2016) on kangaroo mother care (KMC) demonstrated a significant reduction in the risk of mortality in low birth weight infants. New evidence from large multi-centre randomised trials...

New WHO Recommendations for the Care of Preterm and Low Birth Weight Infants–A Potential Strategy to Transform the Current Healthcare Needs of Neonates

New WHO Recommendations for the Care of Preterm and Low Birth Weight Infants–A Potential Strategy to Transform the Current Healthcare Needs of Neonates

Nurses' Performance about Creating Healing Environment and Clustering Nursing Care for Premature Infants

Premature infants have markedly improved outcomes when the stress of environmental sensory overstimulation is reduced. Nurses, as the primary caregivers, play a crucial role in reducing infants' stress and promoting better outcomes.

The Effect of Seven Developmental Care Models on Mothers' Stress and Premature Infants' Length of Hospitalization

The Neonatal Integrative Developmental Care Model (NIDCM) is a holistic model of premature infant care that refers to the seven neuroprotective developmental care cores involving the family. This study aimed to assess the effect of the application of NIDCM on mothers’ stress response and length of stay in the neonatal care unit. This study used quasi-experimental with nonequivalent control group pre and posttest design. This study was carried out in the neonatal care unit at RSUP Dr. Wahidin Sudirohusodo Makassar from January 2020 to April 2021. The samples were 76 subjects consisting of 38 premature infants (19 controls, 19 interventions) and 38 mothers (19 controls, 19 interventions) ethical clearance by the Health Research Ethics Committee of the Faculty of Medicine, Universitas Hasanuddin No. 938/UN4.6.4.5.51/PP36/2009. The results show 1) NIDCM is proven to be able to reduce maternal stress more compared to routine Developmental Care (DC); 2) NIDCM is proven to shorten the length of stay compared to routine DC in infants with a gestational age of ≥33 weeks with BW ≥1800 grams (Median : 1900 grams), while in infants with a gestational age of <33 weeks and BW <1800 grams (Median : 1650 grams), NIDCM and routine DC are not proven to shorten the length of stay. It can be concluded that applying NIDCM reduces the stressors felt by mothers while their infants are in the neonatal room. In addition, the condition of infants with birth weights less than 1800 grams needs special attention with NIDCM intervention.

Assessment of the Adherence to ESPGHAN 2018 Guidelines in the Neonatal Intensive Care Unit of the Ghent University Hospital: A Retrospective Study.

Parenteral nutrition (PN) is a standard of care for preterm infants in the first postnatal days. The European Society of Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) has updated their guideline recommendations on PN in 2018. However, data on actual 2018 guideline adherence in clinical practice are sparse. In this retrospective study, conducted at the neonatal intensive care unit (NICU) of Ghent University Hospital, we analyzed the ESPGHAN 2018 PN guideline adherence and growth for 86 neonates admitted to the NICU. Analyses were stratified by birth weight (<1000 g, 1000 to <1500 g, ≥1500 g). We documented the provisions for enteral nutrition (EN) and PN, and we tested the combined EN and PN provisions for ESPGHAN 2018 adherence. The nutrition protocols showed a high adherence to PN guidelines in terms of carbohydrate provisions, yet lipid provisions for EN and PN often exceeded the recommended maximum of 4 g/kg/d; although, PN lipid intakes maxed out at 3.6 g/kg/d. Protein provisions tended to fall below the recommended minimum of 2.5 g/kg/d for preterm infants and 1.5 g/kg/d for term neonates. The energy provisions also tended to fall below the minimum recommendations, especially for neonates with a birth weight (BW) < 1000 g. Over a mean PN duration of 17.1 ± 11.4 d, the median weekly Fenton Z-scores changes for length, weight, and head circumference were positive for all BW groups. Future studies have to assess how protocols adapt to current guidelines, and how this affects short- and long-term growth across different BW groups. In conclusion, the reported findings provide real-world evidence regarding the effect of ESPGHAN 2018 PN guideline adherence, and they demonstrate how standardized neonatal PN solutions can safeguard stable growth during NICU stays.

Dilemmas in establishing preterm enteral feeding: where do we start and how fast do we go?

Beginning and achieving full enteral nutrition is a key step in the care of preterm infants, particularly very low birth weight (VLBW) infants. As is true for many organ system-specific complications of prematurity, the gastrointestinal tract must complete in utero development ex utero while concurrently serving a physiologic role reserved for after completion of full term development. The preterm gut must assume the placental function of the interface between a source of energy, precursors for anabolism, and micronutrients, and the developing infant-through digestion and absorption of milk, instead of directly from the mother via the uteroplacental interface. The benefits of enteral nourishment in preterm infants are counterbalanced by gastrointestinal complications of prematurity: dysmotility leading to difficulty establishing and advancing feeds, and the risk of necrotizing enterocolitis (NEC). Concern for these complications can prolong the need for parenteral nutrition with an associated increase in risk for central line-associated bloodstream infection (CLABSI) and parenteral nutrition (PN)-associated cholestasis or liver disease (PNALD). Thus, a daily issue facing neonatologists caring for preterm infants is how to optimally begin, advance, and reach full enteral nutrition sufficient to satisfy the nutrient, energy, and fluid requirements of VLBW infants while minimizing risk. In this perspective, we provide an overview of the approaches and supporting data for starting and advancing enteral feeds in preterm infants, particularly very low birth weight infants, and we discuss the significant gaps in knowledge that accompany current approaches. This framework recognizes the dilemmas of preterm feeding initiation andadvancement and identifies areas of opportunity for further investigation.

Ophthalmological follow-up of premature children in St. Petersburg

Premature newborns have a high risk of developing visual impairments. This study presents the experience of an organization dispensary ophthalmological observation as a stage of providing medical care to premature children in St. Petersburg and the prospects for its development.&#x0D; AIM: To analyze the effectiveness of the organizational model of dispensary ophthalmological observation of premature children in St. Petersburg for 20202022.&#x0D; MATERIAL AND METHODS: Reporting forms of the activities of interdistrict ophthalmological cabinet and reporting forms of medical and social expertise of Rosstat No. 7D were used.&#x0D; RESULTS: In 2010, a system of specialized ophthalmological care for premature infants at the hospital stage was organized in St. Petersburg (screening and laser treatment of active ROP using telemedicine technologies; surgical treatment of late disease stages). In 2018, for the subsequent dispensary observation of premature children aged up to 3 years, six inter-district ophthalmological cabinets of follow-up were organized. A developed routing scheme for children at risk and with active and cicatricial ROP in St. Petersburg and preliminary results of ROP incidence were presented.&#x0D; CONCLUSION: The activities of specialized inter-district follow-up cabinets primarily ensure continuity between hospital and outpatient services in the dynamic monitoring of children at risk and children with active ROP. In addition, professional competencies allow ophthalmologists to avoid mistakes in diagnosing the stage, monitoring the ROP course, and promptly referring patients for emergency treatment (laser or anti-VEGF therapy).

WHO Global Position Paper and Implementation Strategy on kangaroo mother care call for fundamental reorganisation of maternal–infant care

WHO Global Position Paper and Implementation Strategy on kangaroo mother care call for fundamental reorganisation of maternal–infant care

Parents and healthcare professionals' attitudes to Kangaroo Care for preterm infants in the United Kingdom.

To explore the attitudes of parents and healthcare professionals (HCPs), and facilitators and barrier to implementation of Kangaroo Care (KC) in the United Kingdom. Online cross-sectional survey; distributed via the British Association of Perinatal Medicine, Bliss (UK-based charity), social media. Sixty HCPs responded. 37 (62%) were nurses/nurse practitioners. 57 (95%) regularly implement KC. The most important factor that supported KC implementation was the team's belief in benefits of KC. Increased workload, staff shortage and fear about safely of KC in unwell infants were recognised as the challenges preventing implementation. Five hundred eighteen parents responded. 421 (81%) had a preterm baby within 3 years. 338 (80%) were familiar with KC. The main facilitator was the belief that their baby enjoyed it. Excess noise and crowding on the unit were the most frequently reported barriers. Lack of opportunity and limited staff support were the main reasons why they had been unable to practice KC. We found that most HCPs and parents believe that KC is beneficial and would like to practice it. Lack of resources to enable effective implementation is the main barrier. Service development and implementation research is required to ensure that KC is delivered in all UK neonatal units.

The clinical experience of early skin-to-skin contact combined with non-nutritive comfort sucking in mothers of preterm infants: a qualitative study

BackgroundIn most areas of China, mothers typically do not participate in early care of preterm infants in NICU. This study aims to examine the early experience of mothers of preterm infants participating in skin-to-skin contact combined with non-nutritive comfort sucking in China.MethodsThis qualitative research study used one-on-one, face-to-face, semi-structured in-depth interviews. Eighteen mothers who participated in early skin-to-skin contact combined with non-nutritive comfort sucking were interviewed in the NICU of a tertiary children’s hospital in Shanghai between July and December 2020. Their experiences were analyzed using the inductive topic analysis method.ResultsFive themes about skin-to-skin contact combined with non-nutritive comfort sucking were identified, including alleviation of maternal anxiety and fear during mother infant separation, reshaping the maternal role, promotion of active breast pumping, enhances the mother’s willingness to actively breast feed and building the maternal confidence in baby care.ConclusionSkin-to-skin contact combined with non-nutritive comfort sucking in the NICU can not only enhance the identity and responsibility of the mother’s role, but also provide non-nutritive sucking experience for promoting the establishment of oral feeding in preterm infants.

The H-HOPE behavioral intervention plus Kangaroo Mother Care increases mother-preterm infant responsivity in Malawi: a prospective cohort comparison

BackgroundEarly behavioral intervention to promote development is recommended as the standard of care for preterm infants, yet is not provided in Malawi. One such intervention is H-HOPE (Hospital to Home: Optimizing the Premature Infant’s Environment). In US studies, H-HOPE increased mother-preterm infant responsivity at 6-weeks corrected age (CA). Kangaroo Mother Care (KMC) improves infant survival and is the standard of care for preterm infants in Malawi. This is the first study to examine whether H-HOPE is feasible and promotes mother-preterm infant responsivity in Malawi, and the first to examine the impact of H-HOPE when KMC is the standard of care.MethodThis pilot was conducted in a KMC unit using a prospective cohort comparison design. Because the unit is an open room without privacy, random assignment would have led to contamination of the control cohort. H-HOPE includes participatory guidance for mothers and Massage + , a 15 min multisensory session provided by mothers twice daily. H-HOPE began when infants were clinically stable and at least 32 weeks postmenstrual age. Mothers participated if they were physically stable and willing to return for follow-up. Mother-preterm infant dyads were video-recorded during a play session at 6-weeks CA. Responsivity was measured using the Dyadic Mutuality Code (DMC).ResultsThe final sample included 60 H-HOPE + KMC and 59 KMC only mother-preterm infant dyads. Controlling for significant maternal and infant characteristics, the H-HOPE + KMC dyads were over 11 times more likely to have higher responsivity than those in the KMC only dyads (AOR = 11.51, CI = 4.56, 29.04). The only other factor related to higher responsivity was vaginal vs. Caesarian delivery (AOR = 5.44, CI = .096, 30.96).ConclusionThis study demonstrated that H-HOPE can be provided in Malawi. Mother-infant dyads receiving both H-HOPE and KMC had higher responsivity at 6-weeks CA than those receiving KMC only. H-HOPE was taught by nurses in this study, however the nursing shortage in Malawi makes H-HOPE delivery by nurses challenging. Training patient attendants in the KMC unit is a cost-effective alternative. H-HOPE as the standard of care offers benefits to preterm infants and mothers that KMC alone does not provide.

Determinants of Implementation of Kangaroo Mother Care Services among Healthcare Workers in Makueni County, Kenya

Purpose: Kangaroo Mother Care (KMC) entails infants and mothers having constant skin-to-skin contact. KMC is done in the hospital after delivery to preterm infants or after early discharge. Mothers or caregivers are sensitized on proper positioning, breastfeeding, hygiene, and preventive measures to protect infants from infections. Proper follow-up is critical to ensure effective results are achieved. The use of KMC was endorsed by the World Health Organization (WHO) as routine care for preterm infants with a birth weight of ≤2000 grams, especially the clinically stable infants. This recommendation was based on the available moderate-quality evidence that it works by providing warmth (thermal care) and increasing breastfeeding opportunities irrespective of setting, birth weight, or gestational age. Also, KMC has been strongly acclaimed and used as a natural thermoregulator, infection prevention, and nutrition for preterm infants, which are critical for physiological functions that are strongly affected by physical immaturity. Although this technique offers quality care to these babies, its implementation is low. There is a need to determine the suitable methods to improve its implementation in Kenya's healthcare facilities. This study aimed to determine factors influencing the implementation of KMC in Makueni County health facilities.&#x0D; Methodology: The study was conducted in maternity units of six sub-county hospitals (Makueni county referral hospital, Makindu sub-county hospital, Kibwezi sub-county hospital, Mbooni sub-county hospital, Kilungu sub-county hospital, and Sultan-Hamud sub-county hospital) in Makueni County. Cross-sectional study design with mixed methods was used. Semi-structured questionnaires and KMC checklist were filled by the researcher and research assistants. The convenience sampling technique was carried out, and 90 healthcare providers and 6 Key Informants were interviewed. Data was analyzed using version 23 of a statistical package for social sciences using descriptive and inferential statistics.&#x0D; Findings: The study results reveal that young health care providers portrayed better KMC implementation compared to the old (r=-.210, p=0.047). In relation to gender, female health care providers had better KMC implementation compared to the male (r= -.290, p=0.006).Knowledge (r=.282, p=0.007) and health workers' perception of KMC (r=.245, p=0.02) had a positive and significant relationship with implementing KMC. Perception (β=1.149, p=0.05) and funds (β=0.958, p=0.05) had a positive and significant effect on implementing KMC. R squared indicated that jointly, age, gender, perception, and budget accounted for 29.4% of the overall variation in the KMC implementation. Results demonstrated a high level of KMC (33.3%) implementation among the health facilities. The study concluded that funds and collaboration had a positive and significant effect on implementing KMC.&#x0D; Unique Contribution to Theory, Practice and Policy: The study recommends that the hospital management should ensure there is provision of adequate resources to support KMC implementation. In particular, the hospital management should focus on strengthening physical and human resources. There is also a need to link all relevant programs, such as essential newborn care and Integrated Management of Neonatal and Childhood Illnesses (IMNCI), to support KMC implementation.

The Necessity of Implementing Clustered Care in Preterm Infants.

The Necessity of Implementing Clustered Care in Preterm Infants.

Review Article: Skin Condition and Skin Care in Premature Infants

Background: The majority of newborn skin care recommendations focus on concerns for healthy, full-term infants. Compared to mature infants, the skin of premature infants, those who are born at the gestational age of 37 weeks, is more vulnerable to injury, transepidermal water loss (TEWL), and transepidermal intoxication. There are no established guidelines for premature infant skin care. Discussion and review regarding this topic are needed. Purpose: To review the literature on skin conditions and skin care in premature infants. Review: The barrier function of premature skin is significantly compromised because the stratum corneum does not fully mature until late in the third trimester. Premature infants have immature skin with impaired barrier function characterized by high TEWL, increased absorption of chemicals, and increased risk of infection. Some particular issues in premature infant skin are controlling TEWL, avoiding mechanical damage, proper sterilization to control infection, awareness of percutaneous drug toxicity, appropriate bathing and umbilical cord care, and appropriate management of skin problems. Conclusion: Premature infant skin is more vulnerable due to immature development. Skin care for premature infants requires careful attention.

Nurses' knowledge, perceived challenges, and recommended solutions regarding premature infant care: A mixed method study in the referral and tertiary hospitals in Dar es salaam, Tanzania.

There has been an increase in preterm birth of about 2% in a span of 14 years (2000-2014) mainly from Asia and Sub-Saharan Africa. Nursing care is very crucial and a lack of knowledge of health care providers is a contributing factor to morbidity and mortality. With the increasing number and investment of preterm infants towards attaining sustainable development goals (SDG) 3.2, nurses' knowledge adequacy, challenges and solutions on their care needs to be affirmed. A mixed method study was conducted between September 2020 to January 2021 in the neonatal units of four hospitals in Dar es Salaam. Self-administered structured questionnaire was used to assess adequacy of knowledge set at 50% or more for the three main domains 1) Essential newborn Care 2) Infection prevention and management 3) Special care and monitoring. A phenomenological design using a structured interview guide focused on challenges and recommended solutions in acquiring on-the- job training on the care of preterm infants. Quantitative data were analyzed using SPSS version 23 and qualitative data were thematically categorized. Out of 52 of nurses who participated and providing care to preterm infants; 48.1% came from a tertiary hospital, (84.6%) were females, only 28.8% aged more than 40 years and 23.1% had less than one year of experience. Overall, 55.8% of the nurses had never received on job training. Adequate knowledge among nurses was 94% on essential newborn care, 80.8% on infection prevention and management and 36.5% on special care and monitoring of preterm infants. Generally, immediate actions of helping baby breath (HBB) and cord care scored poorest. Components on special care and monitoring which had lowest scores included blood glucose monitoring, temperature monitoring and acceptable daily weight gain. Being more than 41 years old, a female nurse and working in the neonatal unit for at least 1-3 years were more likely to determine adequacy of knowledge on infection prevention and management. Lack of schedule and ways to identify those who require training were among the challenges mentioned in the focus group discussion. The findings demonstrate an urgent need of instilling knowledge, skills and competences among nurses providing preterm care in our hospitals. Most nurses had not attended training on the care of premature infant. Special care and monitoring were most poorly performed. The recommended solutions included continuous medical education (CME) for all nurses through hospital and government commitment and encourage mentorship within and between hospitals. Nurses who are female, older than 41 years and those with 1 to 3 years of experience should be considered when planning for CME and mentorship program on infection prevention and management.

Reception, Quality of Care and Attitude of Maternal and Neonatal Care Providers at The Maternity of The Reference Health Center of Fana (Mali)

The aim was to assess the satisfaction ofwomen giving birth with the reception, the quality of care and the attitude of maternal and neonatal care providers. Materials and methods: This was a prospective descriptive analytical cross-sectional study over a 6-month periodfrom February 1, 2019 to July 31, 2019 in Fana. Results: The average age of women was 27.5 years with extremes of 15 and 40 years. They were 98.2% married. And 90.1% of them took care of their household. They were educated in 27.1% with only 2.6% who had a higher level of education. Direct admissions were 80% and referrals/evacuations accounted for 20% of the workforce. Pregnant women performed between 1 and 4 antenatal care in 87.2% and 4.8% did not provide any care. The majority of them consulted in the 3rd trimester of pregnancy. Pregnant women gave birth vaginally in 76.6% compared to 23.4% of caesarean section. Instrumental extractions are performed in 1.3% with 6cases of forceps and 2cases of suction cup. Hemorrhage, eclampsia, uterine rupture and infection are the main maternal complications observed. 99.2% of the care provided by qualified personnel. Care for sick and premature infants was inadequate. 98.7% of women gave birth were satisfied with the care. Conclusion: The quality of obstetric and neonatal care was generally satisfactory.

Early Skin-to-Skin Contact in Preterm Infants: Is It Safe? An Italian Experience.

Skin-to-skin contact (SSC) is one of the four components of kangaroo care (KC) and is also a valued alternative to incubators in low-income countries. SSC has also become a standard of care in high-income countries because of its short- and long-term benefits and its positive effect on infant growth and neurodevelopmental outcome. However, barriers in the implementation of SSC, especially with preterm infants, are common in NICUs because parents and health care professionals can perceive it as potentially risky for the clinical stability of preterm infants. Previous studies have assessed safety before and during SSC by monitoring vital parameters during short-time intervals. To demonstrate the safety of early SSC in preterm infants during at least 90 min intervals. Prospective observational monocentric study. Preterm infants born between June 2018 and June 2020 with a gestational age of ≤33 weeks and a birth weight of <2000 g were monitored while performing an SSC session during the first three weeks of life. Infants with necrotizing enterocolitis, sepsis, and congenital malformations on mechanical ventilation or with more than five apneas in the hour before SSC were excluded. Continuous oxygen saturation (SaO2), heart rate (HR), and respiratory rate (RR) were registered during an SSC session and in the hour before. The minimum duration of an SSC session was 90 min. Information regarding postmenstrual age (PMA), body weight, respiratory support, presence of a central venous catheter and the onset of sepsis within 72 h after a session was collected. Two physicians, blinded to infant conditions and the period of analysis (before or during SSC), evaluated desaturation episodes (SaO2 < 85%, >15 s), bradycardia (HR < 100, >15 s) and apneas (pause in breathing > 20 s associated with desaturation and/or bradycardia). A Wilcoxon rank sum test was used for the statistical analysis. In total, 83 episodes of SSC were analyzed for a total of 38 infants. The mean gestational age at birth was 29 weeks (range 23-33 weeks). Median PMA, days of life, and body weight at SSC were 31 weeks (range 25-34 weeks), 10 days (range 1-20 days), and 1131 g (range 631-2206 g), respectively. We found that 77% of infants were on respiratory support and 47% of them had a central venous catheter (umbilical or peripherally inserted central catheter) during SSC. The total duration of desaturation, bradycardia, and the number of apneas were not statistically different during the SSC session and the hour before. No catheter dislocation or ruptures were reported. These findings highlighted the safety of early SSC in preterm infants and the possibility of performing it in an intensive care setting in the first weeks of life. In addition, these findings should reassure health care professionals offering this practice as a standard of care. SSC plays a key role in the care of preterm infants due to its short- and long-term positive benefits, and it deserves to be increasingly offered to infants and their parents.

Dose-related cardiac outcomes in response to postnatal dexamethasone treatment in premature lambs.

Postnatal corticosteroids are used in the critical care of preterm infants for the prevention and treatment of bronchopulmonary dysplasia. We aimed to investigate the effects of early postnatal dexamethasone therapy and dose on cardiac maturation and morphology in preterm lambs. Lambs were delivered prematurely at ~128 days of gestational age and managed postnatally according to best clinical practice. Preterm lambs were administered dexamethasone daily at either a low-dose (n=9) or a high-dose (n=7), or were naïve to steroid treatment and administered saline (n=9), over a 7-day time-course. Hearts were studied at postnatal Day 7 for gene expression and assessment of myocardial structure. High-dose dexamethasone treatment in the early postnatal period led to marked differences in cardiac gene expression, altered cardiomyocyte maturation and reduced cardiomyocyte endowment in the right ventricle, as well as increased inflammatory infiltrates into the left ventricle. Low-dose exposure had minimal effects on the preterm heart. Neonatal dexamethasone treatment led to adverse effects in the preterm heart in a dose-dependent manner within the first week of life. The observed cardiac changes associated with high-dose postnatal dexamethasone treatment may influence postnatal growth and remodeling of the preterm heart and subsequent long-term cardiac function.

Disseminating MSSA Infection in a Preterm Infant With Rare Finding of Spinal Epidural Abscess: A Case Report.

Methicillin-susceptible Staphylococcus aureus (MSSA) occurs more frequently in the neonatal intensive care unit (NICU) than methicillin-resistant S. aureus (MRSA) and can result in comparable morbidity and mortality in the neonatal population. MSSA infection may present as pustulosis or cellulitis and evolve into bacteremia, pneumonia, endocarditis, brain abscesses, and osteomyelitis. There is a paucity of literature regarding the treatment and long-term outcomes in the premature infant. A 32-week twin developed MSSA sepsis with presentation of pain, decreased movement of upper extremities, and global hypotonia. Blood cultures remained positive despite antibiotic coverage. The infant was admitted to the level IV NICU with the diagnosis of MSSA bacteremia, with concern for dissemination and osteomyelitis. Diagnostic studies included laboratory testing for sepsis evaluation, radiologic studies to evaluate for dissemination, immunologic testing to rule out complement deficiency, and hematology testing to rule out hypercoagulable conditions. Diagnostic testing showed extensive cellulitis, osteomyelitis, multiple liver abscesses, and epidural abscesses suggestive of spinal epidural abscess (SEA). Abscess debridement and irrigation on the left distal femur, left elbow, and right tibia were performed. The infant completed 8 weeks of IV antibiotic therapy. Immunologic and hematology testing was within normal limits. Prompt recognition and follow-up for clinical signs of sepsis are vital when caring for premature infants. Inclusion of pediatric subspecialist recommendations to assure all diagnostic studies and treatments are completed can significantly impact the patient's outcome. Long-term follow-up is needed for premature infants with the diagnosis of SEA.