Premature infant aftercare / monitor consultation
Information for doctors
According to a GBA decision of 01.01.2006, all Perinatal Centers Level 1 must conduct developmental neurological follow-up examinations of the premature babies they care for with a GG of < 1500 g at the age of 2 years, including the MHH.
In addition to a physical examination and collection of biometric data, a differentiated examination of psychomotor development is performed using Bayley II or Griffith scales. Parents are informed about the follow-up examination before discharge from the clinic. The actual appointment is made 6 - 8 weeks before by a written invitation from the outpatient clinic. We kindly ask all pediatricians caring for the respective premature babies to issue the appropriate referral. You will of course receive a detailed report with the results of the examination and the corresponding recommendations resulting from the findings.
The project "Follow-up examination of premature babies with a gestational age below the completed 28th week of pregnancy" is currently running in Lower Saxony and Bremen. The project provides for standardized, documented examinations of premature infants in pediatric clinics or in social pediatric centers at currently three fixed points in childhood:
- corrected age of 6 months
- corrected age of 2 years
- chronological age of 5 years
All pediatric clinics in Lower Saxony and Bremen that care for premature infants with a GA < 28 SSW participate in the project. The main goal of the project is to further develop the quality of care for very small premature infants. It is the first approach of a cross-sectoral quality analysis. The project does not interfere with the current care of preterm infants, but is intended to provide valid data on the long-term development of preterm infants throughout the country and also to further support the exchange of information between all those involved in the care of these children. The parents have already been informed about the project in the clinic and have agreed to participate. The appointment with the parents is arranged directly by the clinic or the SPC. We kindly ask all pediatricians to make a contribution to bringing the project to a successful conclusion with their referral. If you are interested in learning more about the project, you are welcome to request a more detailed project description at the following address:
Gabriele Damm, Center for Quality and Management in Health Care, Institution of the Medical Association of Lower Saxony, Phone: +49 511 380-2507, Fax: +49 511 380-2118, Email: firstname.lastname@example.org.
In the case of home monitoring, oxygen saturation and heart rate are usually monitored. According to the recommendations of the American Academy of Pediatrics (Apnea, Sudden Infant Death Syndrome, and Home Monitoring. Pediatrics 2003;111:914-917), only monitors with memory function are used for home monitoring (concerns both the storage of events primarily defined by the individual setting of limits for oxygen saturation and heart rate and the continuous storage of the last 36 hours of recording time). The recordings of the home monitors can be digitized and viewed on the computer using appropriate software. This enables an objective evaluation of the events. Furthermore, it is possible to see exactly when and for how long the monitor was used.
The indications for home monitor monitoring and the duration of home monitoring vary depending on the underlying pathology.
Premature infants with persistent apnea-bradycardiac symptoms are usually monitored until 4 weeks after the calculated date of birth, because then the symptoms have been suspended in almost 100% of cases. If this is not the case, the monitoring interval is extended by 4 weeks.
Infants who are monitored due to oxygen dependency should generally be monitored for 1 - 2 months after the end of oxygen dependency. If this time falls in the winter season with the increased risk of pulmonary infections, monitoring is usually continued until the end of the winter season. Similarly, tracheostomized children are monitored for 1 - 2 months beyond the time of tracheostoma occlusion, or longer if additional oxygen is required.
Infants following a life-threatening event should be monitored for 4 weeks, as during this time the risk of recurrence of such an event is about 30%.
The indication for home monitoring in SIDS siblings is usually parental concern that such an event will happen again. From a medical point of view, such monitoring is difficult to justify because on the one hand, the risk for the sibling to die from SIDS is only slightly increased and, for example, babies from smoking parents or babies who are laid on their stomachs have a significantly higher risk but are not monitored and, on the other hand, there is no data available to prove that home monitoring actually prevents sudden infant death.
However, if two children in a family have died of SIDS, there is a clear medical indication for monitoring. In principle, monitoring should be done for the first 9 months of life, as 95% of all SISD cases occur during this period. The remaining 5% of cases occur until the age of 5 years. If the sudden infant death of the sibling has occurred at an age of more than 9 months, monitoring should be carried out 1 month after the sibling's death. Here too, it is very important that an event recording is made.