Published online April 27, 2009
PEDIATRICS Vol. 123 No. 5 May 2009, pp. e878-e886 (doi:10.1542/peds.2008-2568)
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ARTICLE

Infant Functional Status: The Timing of Physiologic Maturation of Premature Infants

Susan Bakewell-Sachs, PhD, RNa, Barbara Medoff-Cooper, PhD, RNb,c, Gabriel J. Escobar, MDd,e, Jeffrey H. Silber, MD, PhDc,f,g,h,i and Scott A. Lorch, MD, MSCEc,g,i

a School of Nursing, Health, and Exercise Science, College of New Jersey, Ewing, New Jersey
b School of Nursing
i Leonard Davis Institute of Health Economics
h Department of Health Care Management, the Wharton School, University of Pennsylvania, Philadelphia, Pennsylvania
c Department of Pediatrics
f Departments of Pediatrics and Anesthesiology and Critical Care Medicine
g Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
d Systems Research Initiative and Perinatal Research Unit, Northern California Kaiser Permanente Division of Research, Oakland, California
e Department of Inpatient Pediatrics, Kaiser Permanente Medical Centers, Walnut Creek/Antioch, California

OBJECTIVE. To describe the maturation of physiologic milestones in preterm infants born between 24 and 32 weeks' gestational age.

METHODS. We abstracted daily physiologic maturity information on 865 infants born at ≤32 weeks' gestation in the Northern California Kaiser Permanente Medical Care Program between 1998 and 2001. Data included ventilator and incubator settings, body temperature, apnea and bradycardia spells, use of methylxanthines, feeding method, and requirements for intravenous fluids. Multivariable quantile regression models identified risk factors associated with longer postmenstrual age to achieve various physiologic milestones, including time to full oral feeding, time to wean from supplemental heat, the last day with an apnea or bradycardia episode, the last day on methylxanthine medications, and the last day on supplemental oxygen.

RESULTS. Most milestones were achieved between 34 and 36 weeks' postmenstrual age, although there were wide variations between patients. In most cases, feeding and oxygen milestones were achieved last. For each milestone there was a monotonic relationship between birth gestational age and the median achievement postmenstrual age. However, bronchopulmonary dysplasia and necrotizing enterocolitis strongly influenced these results in infants of younger gestational age.

CONCLUSIONS. This study provides epidemiologic data describing the achievement of basic physiologic milestones that influence the discharge of a premature infant. This work serves as an additional contribution in the development of algorithms to monitor the progress of neonates through their initial hospitalization and provides a reference population for future interventions to improve the physiologic maturation of prematurely born infants.

Key Words: premature infant • feeding • apnea of prematurity • temperature regulation • bronchopulmonary dysplasia

Abbreviations: KPMCP—Kaiser Permanente Medical Care Program • PMA—postmenstrual age • BPD—bronchopulmonary dysplasia • IFS—Infant Functional Status Study • NEC—necrotizing enterocolitis • ROP—retinopathy of prematurity • SNAP—Score for Neonatal Acute Physiology

Accepted Jan 12, 2009.


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