Outpatient Care of the Premature Infant

Bybel, Michael DO
Delaney, Catherine A. MD
Coble, Katie MD

Author Information

MICHAEL BYBEL, DO, FAAFP, is director of the Family Medicine Obstetrics Fellowship at Carl R. Darnall Army Medical Center, Fort Hood, Texas, and an assistant professor in the Department of Family Medicine at the Uniformed Services University of the Health Sciences School of Medicine, Bethesda, Maryland.

CATHERINE A. DELANEY, MD, FAAFP, is an associate program director and a faculty member at the Martin Army Community Hospital Family Medicine Residency, Fort Benning, Georgia.

KATIE COBLE, MD, is core faculty at the Eglin Family Medicine Residency, Eglin Air Force Base, Florida.

Author disclosure: No relevant financial relationships.

This article updates previous articles on this topic by Gauer, et al.; LaHood and Bryant; and Trachtenbarg and Golemon.

Data Sources: We searched OvidSP, Institution for Healthcare Improvement, AHRQ, Cochrane Library, and UpToDate. Key words: prematurity, preterm delivery, epidemiology of prematurity, chronic lung disease, bronchopulmonary dysplasia, respiratory syncytial virus, anemia of prematurity, immunizations, neurodevelopmental delay, neurodevelopmental screening tools, gastroesophageal reflux, postdischarge nutrition, nutritional deficiencies, breastfeeding, palivizumab, iron deficiency anemia, and nutrient fortifiers. Essential Evidence Plus was also searched. Search dates: February 2024 to May 2025.

American Family Physician 112(2):p 153-161, August 2025.

Family physicians oversee the complex care of premature infants after discharge from the neonatal intensive care unit, taking into consideration the degree of prematurity and unique complications that can occur. Early family engagement is critical for these infants. Before hospital discharge, at least two caregivers should demonstrate the ability to appropriately feed and provide necessary care for the infant. Premature infants are at risk of hypoxic-ischemic encephalopathy, periventricular leukomalacia, retinopathy of prematurity, bronchopulmonary dysplasia, necrotizing enterocolitis, and intraventricular hemorrhage. Routine vaccination is recommended. This includes newer prevention options for respiratory syncytial virus (eg, nirsevimab [Beyfortus]) and the prenatal vaccine Abrysvo. Growth of premature infants is monitored using corrected age and may improve with use of breast milk fortifiers or enriched formulas. Premature infants are also at risk for neurodevelopmental disabilities, including cerebral palsy, intellectual disability, and vision and hearing impairment. Developmental screening using corrected age is recommended at ages 9, 18, and 30 months, with screening for autism spectrum disorder at 18 and 24 months.