Neonatologia
Dalla Terapia Intensiva Neonatale alla Pediatria di famiglia
From Neonatal Intensive Care Unit to paediatric primary care: discharge planning of preterm infants
Salvatore Aversa, Francesco Maria Risso
UOC di Neonatologia e Terapia Intensiva Neonatale, Presidio “Ospedale dei Bambini”, ASST Spedali Civili, Brescia
Febbraio 2023 - pagg. 103 -109 | DOI: 10.53126/MEB42103
Abstract
Discharge planning of preterm infants and transition from the neonatologist to the primary care paediatrician are key components of family-centred Neonatal Intensive Care Unit care. Growth support and monitoring, feeding choices, management of gastroesophageal reflux, neurodevelopmental issues, clinical follow-up and monitoring at home, screening and recommended vaccinations are issues that the primary care paediatrician will face in caring for these children. Many of the problems extremely preterm infants face are not yet resolved at the time of hospital discharge and will require continued outpatient management by the neonatologist, primary care paediatrician and other members of the multidisciplinary team. Parents will need to participate in a comprehensive discharge planning programme tailored to their infant’s individual needs and family resources. This article discusses the main clinical problems that primary care paediatricians have to face from the day of discharge and the successive care of the preterm infant, which is often very challenging and delicate.
Riassunto
La pianificazione della dimissione dei nati pretermine e il passaggio di consegne dal neonatologo al pediatra di libera scelta sono componenti chiave dell'assistenza in terapia intensiva neonatale incentrata sulla famiglia. Il supporto e il monitoraggio della crescita, le scelte alimentari, la gestione del reflusso gastroesofageo, i problemi di sviluppo neurologico, il follow-up clinico e monitoraggio domiciliare, gli screening e le vaccinazioni raccomandate sono tematiche che il pediatra di libera scelta dovrà affrontare nella cura di questi bambini. Molti dei problemi che i nati estremamente pretermine di peso molto basso devono affrontare non sono ancora risolti al momento della dimissione dall'ospedale e richiederanno una gestione ambulatoriale continua da parte del neonatologo, del pediatra di base e di altri membri del team multidisciplinare. I genitori dovranno essere coinvolti in un programma completo di pianificazione della dimissione che sia stato adattato alle esigenze specifiche individuali del loro bambino e alle risorse familiari. Questo articolo discute i principali problemi clinici che i pediatri devono affrontare dal giorno della dimissione e la successiva presa in carico del neonato pretermine, che è spesso molto impegnativa e delicata.
Parole chiave
Classificazione MeSH
Contenuto riservato
Per leggere l'articolo completo è necessario effettuare il login.
Non sei ancora registrato? Registrati
Bibliografia
1. Anderson N, Narvey M. Discharge planning of the preterm infant. Paediatr Child Health 2022;27(2):129-130. doi: 10.1093/pch/ pxac001.
2. Cao G, Liu J, Liu M. Global, Regional, and National Incidence and Mortality of Neonatal Preterm Birth, 1990-2019. JAMA Pediatr 2022;176(8):787-96. doi: 10.1001/jamapediatrics.2022.1622.
3. Wood NS, Marlow N, Costeloe K, Gibson AT, Wilkinson AR. Neurologic and developmental disability after extremely preterm birth. EPICure Study Group. N Engl J Med 2000;343(6):378-84. doi: 10.1056/NEJM 200008103430601.
4. Serenius F, Ewald U, Farooqi A, et al. Neurodevelopmental Outcomes Among Extremely Preterm Infants 6.5 Years After Active Perinatal Care in Sweden. JAMA Pediatr 2016;170(10):954-63. doi: 10.1001/jamapediatrics.2016.1210.
5. CDC. Preterm Birth Centers for Disease Control and Prevention: U.S. Department of Health and Human Services [Last Reviewed: November 1, 2022]. http://www.cdc.gov/reproductivehealth/maternalinfanthealth/pretermbirth.htm (consultato il 24 gennaio 2023).
6. American Academy of Pediatrics Committee on Fetus and 491 Newborn. Hospital discharge of the high-risk neonate. Pediatrics 2008;122(5):1119-26. doi: 10.1542/peds.2008-2174.
7. Boldrini R, Di Cesare M, Basili F, et al. Direzione Generale della digitalizzazione, del sistema informativo sanitario e della Statistica Ufficio di Statistica. Ministero della Salute. Certificato di assistenza al parto (CeDAP). Analisi dell’evento nascita - Anno 2021. https://www.salute.gov.it/imgs/C_17_pubblicazioni_3264_allegato.pdf (consultato il 24 gennaio 2023).
8. Anderson N, Narvey M. Discharge planning of the preterm infant. Paediatr Child Health 2022;27(2):129-30. doi: 10.1093/pch/ pxac001.
9. Craig JW, Glick C, Phillips R, Hall SL, Smith J, Browne J. Recommendations for involving the family in developmental care of the NICU baby. J Perinatol. 2015;35(Suppl 1):S5-8. doi: 10.1038/jp.2015.142.
10. O’Brien K, Robson K, Bracht M, et al.; FICare Study Group and FICare Parent Advisory Board. Effectiveness of Family Integrated Care in neonatal intensive care units on infant and parent outcomes: a multicentre, multinational, cluster-randomised controlled trial. Lancet Child Adolesc Health 2018;2(4): 245-54. doi: 10.1016/S2352-4642(18)30039-7.
11. Stefana A, Lavelli M. I genitori dei bambini prematuri: una prospettiva psicodinamica. Medico e Bambino 2016;35(5):327-32.
12. Hack M, Fanaroff AA. Outcomes of children of extremely low birthweight and gestational age in the 1990s. Early Hum Dev 1999; 53(3):193-218. doi: 10.1016/s0378-3782(98) 00052-8.
13. Stevenson DK, Wright LL, Lemons JA, et al. Very low birth weight outcomes of the National Institute of Child Health and Human Development Neonatal Research Network, January 1993 through December 1994. Am J Obstet Gynecol 1998;179:1632-9. doi: 10. 1016/s0002-9378(98)70037-7.
14. Gallini F, Fumagalli M, Romeo DM per la Task force sul follow-up del neonato pretermine, Società Italiana di Neonatologia, Istituto Superiore di Sanità. Il Follow-Up del neonato pretermine. I primi sei anni di vita. iDeaCpa Editore, Roma Prima Edizione: 2022. ISBN 978-88-946318-7-6.
15. Jensen EA, Dysart K, Gantz MG, et al. The Diagnosis of Bronchopulmonary Dysplasia in Very Preterm Infants. An Evidence-based Approach. Am J Respir Crit Care Med 2019;200:751. doi: 10.1164/rccm.201812-2348OC.
16. D’Agostin M, Catania MA, Giambrone C, Corsello G. La Neonatologia… caso per caso. Medico e Bambino 2023;42(1):38-44. doi: 10.53126/MEB42038.
17. Eichenwald EC; Committee on Fetus and Newborn, American Academy of Pediatrics. Apnea of Prematurity. Pediatrics 2016;137 (1). doi: 10.1542/peds.2015-3757.
18. McCourt MF, Griffin CM. Comprehensive primary care follow-up for premature infants. J Pediatr Health Care 2000;14(6):270-9. doi: 10.1067/mph.2000.106931.
19. Sulkowski JP, Cooper JN, Duggan EM, et al. Does timing of neonatal inguinal hernia repair affect outcomes? J Pediatr Surg 2015; 50(1):171-6. doi: 10.1016/j.jpedsurg.2014. 10.035.
20. Moon RY, Carlin RF, Hand I; Task Force on Sudden Infant Death Syndrome and the Committee on Fetus and Newborn. Sleep-Related Infant Deaths: Updated 2022 Recommenda-tions for Reducing Infant Deaths in the Sleep Environment. Pediatrics 2022;150 (1):e2022057990. doi: 10.1542/peds.2022-057990.
21. Lopez RN, Lemberg DA. Gastro-oesophageal reflux disease in infancy: a review based on international guidelines. Med J Aust 2020;212(1):40-4. doi: 10.5694/mja2.50447.
22. Quitadamo P, Tambucci R, Mancini V, et al. Esophageal pH-impedance monitoring in children: position paper on indications, methodology and interpretation by the SIGENP working group. Dig Liver Dis 2019;51 (11):1522-1536. doi: 10.1016/j.dld.2019.07. 016.
23. National Collaborating Centre for Women’s and Children’s Health (UK). Gastro-Oesophageal Reflux Disease: Recognition, Diagnosis and Management in Children and Young People. London: National Institute for Health and Care Excellence (UK) (2015). Available at: http://www.ncbi.nlm.nih.gov/ books/NBK293624/ (consultato il 20 gennaio 2023).
24. Chacham S, Pasi R, Chegondi M, Ahmad N, Mohanty SB. Metabolic Bone Disease in Pre-mature Neonates: An Unmet Challenge. JCRPE. 2020;12:332-9. doi: 10.4274/jcrpe.galenos.2019.2019.0091.
25. Ilardi L, Proto A, Ceroni F, et al. Overview of Important Micronutrients Supplementation in Preterm Infants after Discharge: A Call for Consensus. Life (Basel) 2021; 11(4):331. doi: 10.3390/life11040331.
26. Wong HS, Santhakumaran S, Cowan FM, Modi N; Medicines for Neonates Investigator Group. Developmental Assessments in Preterm Children: A Meta-analysis. Pediatrics 2016;138(2):e20160251. doi: 10.1542/ peds.2016-0251.
27. Spittle A, Orton J, Anderson PJ, Boyd R, Doyle LW. Early developmental intervention programmes provided post hospital discharge to prevent motor and cognitive impairment in preterm infants. Cochrane Database Syst Rev 2015(11):CD005495. doi: 10.1002/ 14651858.CD005495.pub4.
28. ESPGHAN Committee on Nutrition, Aggett PJ, Agostoni C, Axelsson I, et al. Feeding preterm infants after hospital discharge: a commentary by the ESPGHAN Committee on Nutri-tion. J Pediatr Gastroenterol Nutr. 2006;42(5):596-603. doi: 10.1097/01.mpg. 0000221915.73264.c7.
29. Young L, Embleton ND, McGuire W. Nutrient-enriched formula versus standard formula for preterm infants following hospital discharge. Cochrane Database Syst Rev 2016;12(12):CD004696. doi: 10.1002/ 14651858.CD004696.pub5.
30. Embleton ND, Wood CL, Pearce MS, Brunskill G, Grahame V. Early diet in preterm infants and later cognition: 10-year follow-up of a randomized controlled trial. Pediatr Res 2021;89(6):1442-6. doi: 10.1038/ s41390-021-01368-y.
31. Baldassarre ME, Panza R, Cresi F, et al.; Italian Society of Paediatrics (SIP), Italian Society of Neonatology (SIN) and Italian Society of Paediatric Gastroenterology, Hepatology and Nutrition (SIGENP). Complementary feeding in preterm infants: a position paper by Italian neonatal, paediatric and paediatric gastroenterology joint societies. Ital J Pediatr 2022;48(1):143. doi: 10.1186/s13052-022-01275-w.
32. Villar J, Giuliani F, Bhutta ZA, et al. Postnatal growth standards for preterm infants: the Preterm Postnatal Follow-up Study of the INTERGROWTH-21st Project. Lancet Glob Health 2015;3:e681-91. doi: 10.1016/S2214-109X(15)00163-1.
33. WHO Child Growth Standards-Methods and development. Geneva: World Health Organization, 2006.
34. Van Dommelen P, Verkerk PH, Van Straaten HL; Dutch Neonatal Intensive Care Unit Neo-natal Hearing Screening Working Group. Hearing loss by week of gestation and birthweight in very preterm neonates. J Pediatr 2015;166(4):840-3.e1 doi: 10.1016/j. jpeds.2014.12.041.
35. Istituto Superiore di Sanità. Screening neonatale uditivo e visivo: raccomandazioni. A cura di Taruscio D, Bubbico L, Salerno P per il Gruppo di studio per lo screening neonatale uditivo e visivo. 2022;115. p. Rapporti ISTISAN 22/17.
36. Fierson WM; American Academy of Pediatrics Section on Ophthalmology; American Academy of Ophthalmology; American Association for Pediatric Ophthalmology and Strabismus; American Association of Certified Orthoptists. Screening Examination of Premature Infants for Retinopathy of Prematurity. Pediatrics 2018;142(6):e20183061. doi: 10.1542/peds.2018-3061. Erratum in: Pediatrics 2019;143(3):PMID:30478242.
37. Hall CB, Weinberg GA, Iwane MK, et al. The burden of respiratory syncytial virus infection in young children. N Engl J Med 2009; 360(6):588-98. doi: 10.1056/NEJMoa0804877.
38. Servadio M, Belleudi V, Marchetti F, Addis A. La profilassi dell’infezione da virus respira-torio sinciziale: dal palivizumab al nirsevimab. Medico e Bambino 2022;41(10):632-9. doi: 10.53126/MEB41632.
39. Esposito S, Serra D, Gualtieri L, Cesati L, Principi N. Vaccines and preterm neonates: why, when, and with what. Early Hum Dev 2009;85(10 Suppl):S43-5. doi: 10.1016/j. earlhumdev.2009.08.011.
Corrispondenza: francesco.risso@asst-spedalicivili.it