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Complications After Preterm Birth: An Overview for Emergency Physicians
Praveen Kumar, MBBS, DCH, MD, ⁎ Gautham Suresh, MD, DM, MS†
Nearly 65000 very low-birth-weight infants are born each year in the United States. Survival of these very premature infants has significantly increased over time with improvements in obstetric and neonatal care such as use of antenatal steroid and postnatalsurfactant therapy, improved resuscitation and ventilation strategies, and use of early enhanced parenteral nutrition. However, a significant proportion of these infants develop either one or more complications of prematurity and may require ongoing care after their discharge. It is estimated that nearly 25% very low-birth-weight infants and as many as 80% extremely low-birth-weight infants have atleast one readmission to the hospital. Many of these infants present to the emergency department with an illness that may be related to the complications of prematurity, and a basic understanding of these morbidities will allow emergency department physicians to provide optimal care to these infants. This article provides a brief summary of common morbidities seen in these high-risk infants. Clin PedEmerg Med 9:191-199 C 2008 Elsevier Inc. All rights reserved. KEYWORDS preterm, very low birth weight, extremely low birth weight, intraventricular hemorrhage, periventricular leukomalacia, apnea of prematurity, bronchopulmonary dysplasia, necrotizing enterocolitis, retinopathy of prematurity

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early 13% of all babies are born preterm in the United States each year, and the proportion oflive births with birth weight not exceeding 1500 g (very low-birthweight [VLBW] infants) has increased gradually from 1.17% to 1.48% over the last 3 decades [1]. This would suggest that, with approximately 4.3 million live births each year, nearly 65000 VLBW infants are born each year in the United States. Over this same period, there has been a significant reduction in mortality rates for this groupof infants, with more than 85% of VLBW infants now surviving to discharge [2]. Nearly one third of these

⁎Division of Neonatology, Northwestern Memorial Hospital, Children's Memorial Hospital, Chicago, IL. †Neonatal Division, Department of Pediatrics, Dartmouth Hitchcock Medical Center, Lebanon, NH. Reprint requests and correspondence: Praveen Kumar, MBBS, DCH, MD, 250 E Superior St, Room05-2159, Northwestern Memorial Hospital, Chicago, IL 60611. (E-mails: p-kumar@northwestern.edu, gautham.suresh@hitchcock.org) 1522-8401/$ - see front matter C 2008 Elsevier Inc. All rights reserved. doi:10.1016/j.cpem.2008.06.009

surviving high-risk infants have had one or more complication of prematurity during their initial hospital stay that may or may not have completely resolved by the time oftheir discharge from the neonatal intensive care unit (NICU). This increase in the number of preterm births combined with increased survival means that an increasing number of these NICU graduates present to primary care physicians and emergency departments (EDs) across the country for their postdischarge care. Many of these visits to EDs are frequently related to an underlying complication afterpreterm birth such as complications of a ventriculoperitoneal (VP) shunt in an infant with posthemorrhagic hydrocephalus (PHH) or respiratory distress in an NICU graduate with bronchopulmonary dysplasia (BPD). It is estimated that nearly 25% of VLBW infants and as many as 80% of extremely low-birth-weight (birth weight ≤1000 g) infants have at least 1 hospital readmission after their dischargefrom the NICU over the first 2 years of life [3]. This trend makes it imperative that all physicians providing care for these 191

192 infants be familiar with the pathophysiology and morbidities unique to these infants. This article will review some of the common complications after preterm birth.

P. Kumar, G. Suresh
on cranial ultrasound screening with no identifiable clinical signs....
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