📌 Section 119.5 – Follow-Up of High-Risk Infants After Discharge (Nelson's 22e) Core Summary

1. Discharge Readiness Criteria
• Stable temperature in open crib (no need for incubator).
• Full oral feeding (breast or bottle) with adequate intake; some may discharge with gavage or gastrostomy tube after parent training.
• Steady weight gain (~30 g/day).
• No significant apnea or bradycardia requiring intervention for at least 5-7 days before discharge.
• Home oxygen may be prescribed for BPD with pulse oximetry monitoring and outpatient follow-up.
• Ophthalmologic exam for ROP if gestational age <30 weeks or birthweight <1500 g.
• Hearing screening completed before discharge.
• Immunizations up to date per chronological age; palivizumab for RSV prophylaxis during season.
• Parental education, skill, and confidence documented (medication administration, oxygen, monitor use, feeding, CPR, recognition of illness).
• Discharge weight typically 1800-2000 g, postmenstrual age >34-35 weeks.

2. Medical Follow-Up After Discharge
• Primary care visit within 2-3 days of discharge.
• Medical home coordinates subspecialty care: pulmonology (BPD, home oxygen), cardiology (PDA, pulmonary hypertension), neurology (IVH, seizures, hydrocephalus), ophthalmology (ROP), audiology (hearing loss), nephrology (hypertension), neurosurgery (VP shunt).
• High risk of poor weight gain, failure to thrive, respiratory infections (RSV), rehospitalization.
• Palivizumab monthly during RSV season for eligible infants (prematurity, BPD, congenital heart disease).

3. Developmental Follow-Up
• Corrected age: Chronological age minus weeks premature. Use for developmental assessment until at least 2 years (some recommend until 3 years).
• High-risk infants born <32 weeks (or <28 weeks or <1000 g) should have formal developmental follow-up.
• Bayley Scales of Infant Development, 4th Edition (Bayley-4): gold standard assessment of cognitive, language, and motor development.
• General Movements Assessment (GMA): can detect cerebral palsy risk within first 3-5 months.
• Hammersmith Infant Neurological Examination (HINE): standardized neurological exam for early CP diagnosis.
• Early intervention (EI) services under IDEA Part C for children <3 years with developmental delay. Early intervention improves cognitive and motor outcomes.
• Cerebral palsy: non-progressive disorder of movement/posture due to immature brain injury; can be diagnosed <6 months using GMA and HINE.
• Long-term risks: learning disabilities, ADHD, executive dysfunction, school difficulties even without major delays.

4. Sequelae of Prematurity
• Respiratory: BPD, pulmonary hypertension, bronchospasm, subglottic stenosis.
• Neurologic: cerebral palsy (spastic diplegia common with PVL), intellectual disability, microcephaly, seizures, post-hemorrhagic hydrocephalus.
• Sensory: hearing loss, ROP-related vision impairment, strabismus, myopia.
• Gastrointestinal: short bowel syndrome (post-NEC), malabsorption, GERD, failure to thrive.
• Hematologic: anemia, osteopenia of prematurity.
• Other: sudden infant death syndrome (SIDS) risk higher, infections, inguinal hernia, hypertension, nephrocalcinosis.

5. Family Support & Social Considerations
• Parental stress, mental health screening, social work support.
• Home visitation programs, Early Head Start.
• Assessment for social risks (child abuse/neglect, substance use, domestic violence).
• Medical home model essential for coordinated, family-centered care.

💡 Pearls: Always use corrected age for developmental milestones until age 2 years. Early intervention (EI) is a legal right for eligible children. The medical home is critical for coordinating complex care. Parental education and confidence are as important as infant readiness for discharge.