Prophylactic examinations

Prophylactic examinations by a general practitioner (GP)

Examinations after the discharge examinations are done by your GP. They are more frequent than in term healthy children. They represent a weekly or twice a month assessment of: the weight, the height and the head circumference, as well as the fontanelles according to premature infants’ growth curves. Healthy premature babies go through a period of accelerated growth in the first months. They quickly reach their peers. Children born weighing less than 1500 g and those especially less than 1000 g cannot catch up with their peers in growth by the third year. The follow-up is done by your pediatrician. You have to right make an examination and a consultation with a neonatologist as per your wish or following a referral by the GP.

Immunizations–they are mandatory and it is recommended to be implemented in time according to the degree of prematurity, the corrected age, any comorbidities, and complications. They are carried out by the GP after consultation with the neonatologist, the treating neurologist, pulmonologist or other professionals, involved in the treatment and monitoring of the child.

Prevention and treatment of premature baby late anemia

Late anemia of the premature baby occurs more often in children born before gestation week 32. It develops at the end of the first month after birth. It is strongest in the 2nd and 3rd month. It is characterized with pale skin and visible mucous membranes (lips, ocular mucosa of the lower eyelid), the child might not be gaining enough weight, might be getting tired faster when, etc. It is found by a blood sample - blood withdrawn from the baby's finger or venous blood. It is appointed by a pediatrician or a neonatologist at the end of the first or second month after discharge of the child. Prophylaxis or treatment with iron preparations, vitamins, and eventually transfusion (blood transfusion), which is performed in a hospital, are initiated in accordance with the results (values of hemoglobin, hematocrit and iron). Periodic monitoring of blood parameters to correct the doses of medicines is necessary.

Premature baby rickets prevention

It is performed with intake of vitamin D in the form of drops. The intake starts during as soon as the stay in the department. It continues after discharge in certain doses and duration as prescribed by the GP.

Prophylactic eye (ophthalmic) examination

Ophthalmologist – eye doctor

Pediatric ophthalmologist – with additional qualification in eye diseases in children. Ophthalmology is the branch of medicine that deals with diseases of the visual analyzer and their treatment. The visual analyzer is an element of fundamental cognitive function for the adaptation of the living organism. 80% of the human sensory information is provided only by sight. Objective: early detection and early treatment of established eye abnormalities. Retinopathy of the premature baby (PH) - sight-threatening condition in premature children. Mandatory eye screening is done in Bulgaria.

In which premature children having an eye examination is mandatory?

  1. Premature infants weighing less than 1500 grams with a gestational age or under gestation week 32
  2. Children on mechanical ventilation for more than 72 hours or on oxygen therapy of over 30 days.

When and by whom is the examination performed?

  1. The first examination is done at week 4-6 by a pediatric ophthalmologist.
  2. The frequency of subsequent examinations is determined by the ophthalmologist.

How is the examination carried out?

  1. By indirect ophthalmoscopy after dilation of the pupils. The examination is short and painless.
  2. Examination with a digital retinal camera (RetCam) is gaining ground as the primary method for the study of premature infants. A local drip anesthesia is administered before the examination together with eye drops to dilate the pupils.

Basic methods of treatment in severe forms of PR are cryotherapy, laser therapy, and surgical treatment.

What you should be careful about?

If after the third adjusted month, your baby is still not reaching for toys, not looking for the view of the mother / the father, does not follow the figure of a man emerging from the room, or it turns one or both eyes to the side - you should contact a pediatric ophthalmologist. Bear in mind that all the above alarming symptoms could also be neurological in nature, so it is best to consult with a pediatric neurologist.

Prophylactic pediatric neurologist examination

Neurologist – a doctor who deals with the treatment of the nervous system and its disorders.

Pediatric neurologist – with additional qualification in diseases of the nervous system in children.

Which children are subject to such an examination and when?

A neurological consultation is required for all premature babies below 2000 grams after 2 months of adjusted age in view of early and timely rehabilitation or other treatment. The purpose is to prevent and / or reduce the possible delay in the motor development of the child. The neurologist may appoint additional tests such as an EEG (electroencephalography), TFU (transfontanelle ultrasound) and others.

Transfontanelle ultrasonography (TFU) is an ultrasound examination, which is non-invasive and provides with important information about the status of the child's brain immediately after birth and later on. The method can be used in the months of suckling until of closure of the large fontanel of the head. The method is harmless, which gives an opportunity for e regular checkup of the brain’s development. Early diagnosis is a prerequisite of timely treatment.

Electroencephalography (EEG) - an examination which helps to measure the electrical activity of the brain. Special sensors are attached to the head - electrode, which are connected to a computer. The computer device records the electrical activity of the brain, and using a monitor or a hard copy, the information can be obtained. It is intended to register the brain wave activity that is altered in a variety of physiological or pathological conditions. It is widely used in the evaluation of epilepsy.


The pediatric neurologist may appoint a consultation exam by a physiotherapist or doctor of physical medicine, if necessary. The kinesiotherapist is a health professional who examines and assesses the functional state of humans and determines the rehabilitation potential; develops and implements kinesitherapeutical programs for the clinically diagnosed by a doctor diseases; conducts specialized treatment, prevention and rehabilitation.

Prophylactic examination by an ENT specialist (oto-rhino-laryngologist – ears, nose, throat)

Which children are subject to such an examination and when?

More often hearing deviations occur in premature infants born weighing less than 1500 grams. Deviations of the hearing can be identified by the treating neonatologist or an ENT specialist before the discharge of the child. The examination is painless and short (5-10 minutes.), with a special equipment for testing of the hearing of the newborn. After the discharge of the baby, a consultation with an ENT specialist should be done as soon as possible upon detecting abnormalities of hearing from the GP or the parents

Prophylactic examination by an orthopedist

Orthopedist – a doctor who deals with problems of bones

Pediatric orthopedist – with additional qualification in diseases of the bone structures in children.

Orthopedics deals with the occurrence, prevention, diagnosis and treatment of congenital and acquired defects in the form or the function of the musculoskeletal system, in other words, bones, joints, muscles and tendons, as well as the rehabilitation of patients.

Which children are subject to such an examination and when?

In premature infants weighing less than 2000 grams at birth. As early as possible after discharge of the child. Normally, a second examination is due after six months of age or at the discretion of consulting orthopedician.

Prophylactic examination by a pulmonologist

Pulmonologist– a physician experienced in the treatment and prevention of respiratory diseases, in particular - the lungs.

Which children are subject to such an examination and when?

In premature infants with a diagnosis of BPD at discharge.

Bronchopulmonary dysplasia (BPD) is a chronic lung disease. The frequency is higher at a gestational age of 30 weeks and weighing less than 1500 g. Those weighing less than 1000 g are most at risk. A consultative examination by a pulmonologist of these children as early as possible after discharge of the child is necessary. The follow-up and the treatment of children with BPD is carried out by a team - a GP (general practitioner), a pediatric pulmonologist, a neonatologist, pediatric cardiologist. The family is also part of the team. It carries out specific and continuous home treatment. In recent years, a specific prevention of RSV infection is being carried out in these children. You will be informed about it by your neonatologist, who will carry out the prophylaxis in the autumn-winter season together with the GP. In the majority of cases, a gradual improvement of clinical symptoms occur, and lung function is normalized till the age of 2. Asthma may develop later in some cases.

Prophylactic pediatric surgeon examination

Surgeon – a specialist doctor in performing surgery.

Pediatric surgeon – with additional qualification in surgical diseases in children.

Which children are subject to a pediatric surgeon examination and when?

The preterm children often develop hernias: umbilical and inguinal.

Umbilical herniation: rarely requires surgery. It is usually corrected with a dressing and subsequent development of the muscles of the anterior abdominal wall.

Inguinal herniations: they are often bilateral and quite large (as walnut or larger), but rarely lead to incarceration (entrapment). Early consultation is mandatory: during the stay in the hospital or following your pediatrician decision on when to refer you to an examination by a pediatric surgeon.


Welcome to  "All About Premature Babies" website.
This is a project of "Our premature babies" Foundation based in Bulgaria. The book is a result of a team’s hardwork that includes doctors, psychologists, breastfeeding consultants and premature babies parents. The common information about premature babies which you can find here will help you understand better the situation you've been facing.
Please keep in mind that some of the information related to the neonatal intensive care units is prevalent only in Bulgaria.

We hope that this website and the book are going to help you to be more informed, calm and confident. We wish you and your baby best of luck and health.

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