Follow-up of Premature Babies

The life of a baby born early runs to a different rhythm after birth. Follow-up of a premature baby is therefore never just about weighing the child or remembering the vaccination schedule. The reason for the early delivery, the problems met at birth, the time spent in intensive care and how the baby grows at home are read together. This assessment allows the growth and developmental differences premature children commonly show to be noticed in time.

This page sets out what the follow-up consists of, why corrected age matters, and which checks need to be planned once you are home. Prematurity is not a diagnosis but a description of the length of pregnancy; your baby's condition is assessed by the doctor, through examination and follow-up.

Why the follow-up of a premature baby is different

A baby born early is not genuinely ready for the outside world on the day of delivery. The lungs, muscles and nervous system still developing in the final part of pregnancy continue to develop after birth. For that reason premature babies cannot be assessed against the same reference points as full-term babies of the same age, and the charts used are different ones.

The second dimension of follow-up is timing. Some checks — the eye screening in particular — are planned for particular weeks, taking into account the gestational age at birth and the time since birth. Developmental follow-up, on the other hand, is interpreted by where the baby actually is in development rather than by chronological age. Holding these two timelines together is what makes the follow-up demanding, and also what makes it safe.

How corrected age is used

The development of premature babies is assessed against corrected age rather than the actual date of delivery. Corrected age is found by subtracting the number of weeks the baby was born early from the baby's actual age since birth. This calculation shows whether the developmental milestones have been reached at the expected point.

A baby whose pregnancy was completed at thirty-two weeks may be at the developmental level of a baby of roughly one month when three months old, and that is not a concerning picture in itself. Corrected age is used for most areas of development up to two years of age, and longer in some areas. The calculation is simple, but applying it incorrectly can make a child's development look slower or faster than it is, so it is kept in view.

How growth is followed

Comparing the growth of a premature baby with the charts of term babies can be misleading, so charts prepared for preterm babies are used. This allows the baby's own line to be followed: length, weight and head circumference are plotted on the same chart, and the question is whether the curve is consistent with itself.

How measurements are taken matters as much as the measurements themselves. For weight, the same scale should be used at a similar time of day. For length, the baby needs to lie flat with the legs straight; for head circumference, the head has to be held correctly. These details may look minor, but they are what shape the growth curve.

How feeding and weight gain are followed

The feeding of a premature baby often depends less on prematurity itself than on the gestational age at birth and the time since the delivery. Some babies breastfeed directly, while others need feeding support alongside breastfeeding. Which approach suits your baby is decided by the strength of the suck, the alertness and the general condition.

The critical point in monitoring weight gain is that the target is individual; not every premature baby follows the same line. Feeding tolerance, vomiting, constipation and the maturing of the digestive system are watched in this period. Some premature babies need iron support, and whether that is required is decided by the doctor. The feeding plan also differs according to the condition your baby was in at homecoming.

How development is followed

In developmental follow-up, motor, language, social and emotional areas are assessed together with the baby observed while awake. Head control, sitting, turning onto the stomach and grasping objects are among the milestones read against corrected age.

Some premature babies show differences in motor development. Part of them close on their own over time, and part require early intervention. Making that distinction is only possible with regular follow-up. If you notice a delay in development, seeking help early matters: early intervention programmes work far better the earlier the concern appears.

Why the eye and hearing checks matter

In premature babies, when the gestational age at birth is below a certain level, an examination of the retina is required. This screening is carried out by an eye doctor, who widens the pupils with drops and examines the retina at the back of the eye, in order to detect problems linked to prematurity before they produce symptoms. When it takes place is planned from the gestational age at birth and the time since birth, and the result is passed to your doctor.

Hearing screening carries its own weight. The initial screening at birth may lead to a more detailed assessment for some infants. Because a hearing problem affects the learning of language directly, early detection and support can be decisive. Infections of the ear and middle ear problems seen during intensive care are also followed.

Vaccinations and protection against infection

The vaccination schedule of a premature baby is the same as that of a term baby for most vaccines. For some of them, the timing may differ in babies with a low birth weight or those who did not respond well after birth. This is set by national protocols and applied by the doctor, because changing the timing on your own leaves a gap in the period when protection matters most.

Alongside vaccinations, simple precautions reduce the risk of infection. Keeping away from crowded places, limiting contact with unwell children, attention to hand hygiene and making sure your baby has the protective flu vaccine all help. Ventilation at home, the sleep routine and feeding also play a protective role.

First steps after coming home

• Write the schedule down clearly: which check falls on which date, and when the screening results will be reviewed.
• Take the measurements under the same conditions: record weight, length and head circumference with the same equipment and at similar times of day.
• Keep a note of feeding: record the length of feeds, changes in milk supply, vomiting and stool characteristics.
• Mark the milestones as they happen: note the dates of the first smile, the first response to a voice and the first head lift.
• Know in advance who to contact: be clear about where to turn for a fever, a change in feeding or a change in breathing.

Common questions

When will my premature baby develop like other children?

The pace of development differs from child to child; in most premature children the differences close during the early years. What matters is how the gap changes. Regular review using corrected age shows which differences close on their own and which need support.

Can I work out the corrected age myself?

The calculation is simple, but how it is applied varies with the area of development being assessed. Getting it right means the developmental assessment is read correctly. It is better to ask your doctor for the corrected age and to use the same figure at each visit.

Should my baby's vaccines be delayed because the baby was born early?

For most vaccines the schedule is the same. For a few, particularly in babies with a low birth weight, the timing may differ; those differences are set by protocols and applied by the doctor. Vaccines protect premature babies just as other babies, so postponing the schedule does not work in your favour.

Does my premature baby get ill more easily?

Premature babies may be more susceptible to certain infections, and how much so depends on the condition of the baby and the time passed. Vaccines, keeping away from crowds and hand hygiene all lower the risk. Where infection is suspected, contact the doctor rather than waiting.

Does my premature baby need developmental support?

That decision follows from the developmental assessment. Regular review identifies areas that need support as soon as they appear, and referral to early intervention programmes can be arranged. The doctor decides which cases require it.