NICU Grad: Answers

This former premie should be gaining a minimum of 15 gm/day, ideally 30 gm/day, so should weigh at least 2120 gm in 7 days. Revised premie growth charts can be found at http://www.biomedcentral.com/1471-2431/3/13.

Yes, breast milk is not only ok, but desirable; however, human milk fortifier should be added until the baby is at term and/or at 2500 gm.   New York State WIC provides human milk fortifier.  After that, powdered formula (Neosure, Enfacare) can be added to breast milk to increase the caloric content to the desired 22cal/oz.  Guidelines for amounts of powdered formula to add can be found (with Spanish translation!) at:  http://www.med.umich.edu/1libr/pa/pa_forminst_hhg.htm

Yes, she should be taking an iron supplement, usually ferrous sulfate drops, at about 2 mg/kg/day.  In addition, she will need vitamin D, usually given in the form of a multivitamin drop; the amount is 1.0 cc/day.  The amounts should be cut in half if infant formula makes up more than half of her intake.

He needs appointments for Ophthalmology, Pediatric Surgery, and Audiology.

His head circumference should increase 0.7-1.0 cm/wk.  An increase over 1.25 cm per week at this point would be excessive and should raise concerns about hydrocephalus.  In that case he would need another appointment:  for a head ultrasound.

Yes, they can both get all regular 2-month vaccines, including the vaccine for hepatitis B.  The older recommendation for waiting to give hepatitis B vaccine to certain premature infants until they weigh 2000 gm no longer holds.  “By age 1 month, medically stable preterm infants, regardless of initial birth weight or gestational age, have a response to vaccination that is comparable to that of full-term infants.” (ACIP, 2005.)

Yes, he (and his sister) can get palivizumab, since they were born at less than or equal to 28 wks gestation and will be younger than 12 mos of age at the start of the RSV “season.”  In our clinics, the pediatric nurses have the forms that must be filled out for home administration of Synagis.

You can tell the twins’ mother that there is an increased risk for neurodevelopmental problems.  They both fall into the ELBW (Extremely low birth weight) category. A 1997 study showed that for infants with BW <1000 grams, 9-12% had cerebral palsy, and 50% of infants went on to require special education services in school.

The brother’s IVH may also become significant to his outcome, especially if he develops hydrocephalus.  They are both at increased risk for ophthalmologic problems and hearing loss as well.

The twins should definitely be referred to Early Intervention.  In New York City, this can be done by faxing a form (see references) to the EI office in the child’s borough.  You will need the infant’s name, DOB, hospital of birth, mother’s name, DOB, address, phone number, diagnosis, and language spoken.