Pediatric Primary Care Case Studies (5 page)

Prematurity Effects on Development

Infants who are born prematurely are at increased risk for growth problems, developmental delays, and complicated medical problems. Recently, survival rates and outcomes for premature infants have improved. In 2006, nearly 13% of all live births in the United States resulted in infants being born prematurely (U.S. National Center for Health Statistics, 2009). When caring for a preterm child in a primary care setting it is important to account for prematurity by monitoring growth and development according to adjusted age (chronologic age minus weeks premature equals corrected gestational age) (LaHood & Bryant, 2007).

From the above review, some other information you should obtain includes the following:

•   Prenatal and neonatal history:

   Current obstetric history including access to prenatal care, infections or illnesses during pregnancy, and alcohol, cigarette, or drug use during pregnancy

   Birth history: gestational age, birth weight, length, head circumference, delivery type, APGAR scores, length of stay in hospital

   Maternal/fetal conditions

   Complications of labor and delivery

   Significant neonatal diagnoses

•   Past medical history:

   Hospitalizations, surgeries, injuries/illnesses; any MRI, chromosomal, or urine genetic diagnostic tests performed

   Source of medical care since birth

   Current medications: over-the-counter, prescribed, supplements, or herbal remedies

   Immunization status

•   Family history:

   Parents’ ages, number of children, medical illness, developmental or psychiatric disabilities, ages and health of siblings, paternal and maternal family history of diseases

•   Social history:

   Insurance coverage, because it may determine where healthcare services can be accessed for developmental problems; educational background; financial and emotional support; dietary considerations

   Values and beliefs