Lesson 6: Home Setting: Post-discharge Feeding and Monitoring
6.3 Continuing monitoring the post-discharge preterm infant
Please refer to Unit 1 Lesson 2.2 of this module for a description of growth charts available for use with preterm infants. When using a validated gender-specific growth chart it is important to perform measurements of weight, length and head circumference accurately. Failure to do so can overlook true growth failure or falsely suggest a deficit.
Detailed descriptions of the standardized anthropomorphic measuring techniques used in the INTERGROWTH-21st study are available here.
Growth and feeding should be assessed at least every 2-4 weeks. Closer monitoring is advisable if the infant was ELBW or is <2000g at time of discharge. In addition, concomitant medical conditions such as complications of NEC or chronic lung disease may alter nutritional needs, therefore such infants will require closer follow-up. If growth failure is present at discharge or develops thereafter, dietary interventions should be started right away and continued until growth parameters are less than two standard deviations from the norm (Lapillonne 2014).
Many preterm infants during their stay at the NICU will go through a postnatal period of parenteral nutrition followed by a transition to enteral feeding, first by tube feeding and then oral feeds, with, for example, increasing time at the breast. Infants may still require "top-up” feeds after a session at the breast. The transition to the regime planned for the home environment should be completed a few days before the anticipated discharge date so that there is time to address and resolve any problems that might arise (i.e feeding tolerance and growth faltering).
Breastfeeding should be encouraged and parents should be advised that human milk is the best for their newborn. Infants should be breastfed every 1.5 h to 3 h, not having pauses of more than 5 hours to keep proper maternal milk supply. In addition, at the discharge, mothers who are breastfeeding their infants should receive contact information for a local lactation consultant or dietician experienced in dealing with preterm infants. A weight check should be performed within 48 hours of leaving the hospital to ensure that intakes at home are adequate (Lapillonne 2014).
