Newborn Screening |
Criteria |
▪ All infants admitted to the NICU |
Initial |
▪ Day 3 or discharge (D/C) date (whichever comes first) |
Follow-up |
▪ Day 14 or D/C date (whichever comes first) |
▪ Day 30 or D/C date (whichever comes first) |
▪ Continue monthly |
▪ On D/C date if more than 7 days since prior screen |
Head Ultrasound (see Chapter 54) |
Criteria |
▪ All infants with gestational age (GA) <32 weeks |
Initial |
▪ Days 7-10 (in the case of critically ill infants, when results of an earlier ultrasonography may alter clinical management, an ultrasonography should be performed at the discretion of the clinician) |
Follow-up (minimum if no abnormalities noted) |
▪ If no hemorrhage or germinal hemorrhage only Week 4 and at 40 weeks’ postmenstrual age (or discharge if <40 weeks) |
▪ If intraventricular (grade 2+) or intraparenchymal hemorrhage: Follow up at least weekly until stable (more frequently if unstable posthemorrhagic hydrocephalus). (Daily head circumference measurement should also be performed in the case of ventricular dilatation.) |
Note: An ultrasound should be done at any GA at any time if thought to be clinically indicated. |
Audiology Screening (see Chapter 68) |
Criteria |
▪ All infants being discharged home from NICU or who are at 34 weeks PMA or greater at the time of transfer to a level 2 nursery |
Timing |
▪ Examine at 34 weeks gestation or greater. |
Car Seat and Car Bed Fit Assessment and Screening |
Criteria |
▪ All infants to be discharged home from NICU and born at <37 weeks or BW <2,500 g or with other conditions that may compromise respiratory status (e.g., chronic lung disease, airway anomalies, and tracheostomy). |
Timing |
▪ Fit assessment or screening prior to discharge home |
Ophthalmologic Examination (see Chapter 67) |
Criteria |
▪ All infants with birth weight ≤1,500 g or GA <31 0/7 weeks |
▪ Infants with a birth weight between 1,500 g and 2,000 g or GA 31 0/7-34 0/7 weeks with high-illness severity (e.g., those who have had severe respiratory distress syndrome, hypotension requiring pressor support, or surgery in the first several weeks of life) per the discretion of the attending neonatologist |
Timing of Initial Exam |
GA |
Postmenstrual Age |
Week after Birth |
22* |
29 |
7 |
23* |
30 |
7 |
24 |
31 |
7 |
25 |
31 |
6 |
26 |
31 |
5 |
27 |
31 |
4 |
28 |
32 |
4 |
29 |
33 |
4 |
30 |
34 |
4 |
31+ |
— |
4 |
* Guidelines have been adjusted slightly from the AAP recommendations per BCH Ophthalmology’s discretion. |
▪ If the infant is transferred to another nursery prior to 4 weeks of age, recommend exam at the receiving hospital. |
▪ If the infant is discharged home prior to 4 weeks of age, examine prior to discharge. |
Follow-up (Based on Most Recent Exam Findings) |
▪ Follow-up examinations should be recommended by the examining ophthalmologist on the basis of retinal findings classified according to the international classification. The following schedule is suggested: |
Stage |
Zone |
Follow-up |
Immature (no ROP) |
I |
≤1 week |
Immature (no ROP) |
posterior II |
1-2 weeks |
Immature (no ROP) |
mid-anterior II |
2 week |
Immature (no ROP) |
III |
3 week |
I |
I |
≤1 week |
I |
II |
2 weeks |
I |
III |
2-3 weeks |
II |
I |
≤1 week |
II |
II |
1-2 weeks |
II |
III |
2-3 weeks |
III |
II |
≤1 week |
Regressing |
I |
1-2 weeks |
Regressing |
II |
2 weeks |
Regressing |
III |
2-3 weeks |
▪ Follow up after resolution of ROP depends on the severity of the active phase of ROP but should occur by age 1 year. The following findings warrant consideration of treatment: |
Stage |
Zone |
I, II, or III with plus disease |
I |
III no plus disease |
I |
II or III with plus disease |
II |
*Guidelines have been adjusted slightly from the AAP recommendations per BCH Ophthalmology’s Discretion |
Hepatitis B Vaccination (see Chapter 48) |
Criteria |
▪ All infants being discharged home from NICU |
Initial |
▪ If weight ≥2,000 g and stable: Vaccinate at birth or shortly thereafter. |
▪ If weight ≥2,000 g and unstable: Defer vaccination until the infant’s clinical condition has stabilized. |
▪ If weight <2,000 g: Vaccinate at 30 days or discharge (whichever comes first). |
Synagis RSV Prophylaxis |
Criteria |
▪ Synagis RSV prophylaxis should be considered from November through March for infants who meet any of the following criteria: |
|
□ GA at birth <29 0/7 weeks |
|
□ GA at birth 29 0/7-31 6/7 weeks with chronic lung disease defined as need for supplemental oxygen for at least 28 days after birth |
|
□ Certain types of hemodynamically significant congenital heart disease |
|
□ Pulmonary abnormality or neuromuscular disease that impairs ability to clear secretions from upper airways |
|
□ Profound immunocompromised condition |
Timing |
▪ Give first dose 48-72 hours before discharge. |
Infant Follow-up Program (IFUP)—Offered at Many Hospitals That Have a Level 3 NICU |
Criteria |
▪ All infants with GA <32 weeks at birth |
Timing |
▪ Referral completed before discharge |
▪ First appointment to be scheduled at 3 months post due date |
Neonatal Neurology Program |
Criteria |
▪ All infants meeting one of the following conditions: |
|
□ Neurologic disorders (e.g., intracranial hemorrhage, neonatal seizures, and stroke) |
|
□ Neuromuscular disorders |
|
□ Recipient of therapeutic hypothermia for HIE |
Timing |
▪ Referral completed before discharge |
Note: Infants with GA <32 weeks at birth should also be referred to IFUP |
Early Intervention Program (EIP) |
Criteria |
▪ Infant meeting four or more of the following criteria: |
|
□ BW <1,200 g |
|
□ GA <32 weeks |
|
□ NICU admission >5 days |
|
□ Apgar <5 at 5 minutes |
|
□ Intrauterine growth restriction (IUGR) or small for gestational age (SGA) (refer to growth curves) |
|
□ Chronic feeding difficulties |
|
□ Suspected central nervous system abnormality |
|
□ Maternal age <17 years or 3 or more births at maternal age <20 years |
|
□ High school education <10 years |
|
□ Parental chronic illness or disability affecting caregiving |
|
□ Lack of family supports |
|
□ Inadequate food, shelter, and clothing |
|
□ Open or confirmed protective service investigation (“51-A”) |
|
□ Substance abuse in the home |
|
□ Violence in the home |
Timing |
▪ Referral completed before discharge |
PMA, postmenstrual age; BW, birth weight; AAP, American Academy of Pediatrics; BCH, Boston Children’s Hospital; ROP, retinopathy of prematurity; RSV, respiratory syncytial virus. |
