Preterm infant — OSCE

Objectives

1. Explain the immediate NICU course in plain language — respiratory support, caffeine, feeding and monitoring. [6] [8]
2. Outline the complications being screened for and the surveillance plan. [11] [12]
3. Give honest, hopeful and probabilistic prognostic counselling without false certainty. [20]
4. Engage parents in family-integrated care and describe the discharge and follow-up pathway. [18]

Candidate brief

12-minute station. The parents are at the bedside of their 29-week infant on day 3. The infant is on CPAP, caffeine has been started, and feeds are advancing as expressed maternal milk. The parents ask: "What happens next? Will our baby be okay? What should we watch for in the future?" They are visibly anxious and the father is worried about brain damage and disability. [6]

Expected actions

• Greet parents warmly, acknowledge their anxiety, and invite them to touch and be near their baby. [18]
• Explain the current support in plain terms: CPAP helps the lungs stay open, caffeine prevents pauses in breathing and protects the brain, and milk feeds are being built up gradually. [6] [8]
• Outline the screening plan: cranial ultrasounds to check for bleeding, eye examinations for retinopathy of prematurity, and ongoing growth monitoring. [11] [12]
• Give probabilistic counselling: outcomes have improved over time, most preterm survivors do well, but there is a real risk of developmental differences that we will monitor and support with early intervention. Avoid both false reassurance and despair. [20]
• Invite the parents into family-integrated care — kangaroo care, participating in feeds and cares, and being part of the team. [18]
• Describe the discharge and follow-up pathway: discharge when feeding, growing and thermally stable; structured follow-up to school age using corrected age. [18]

Examiner prompts

• "Will our baby have brain damage?" → Honest probabilistic answer: cranial ultrasound monitors for bleeding, most infants do well, but we watch and intervene early if needed. [11] [20]
• "How long will we be here?" → Typically discharge is around the original due date, but it depends on feeding, breathing and growth milestones, not a fixed date. [6]
• "What can we do to help?" → Family-integrated care: skin-to-skin, feeding, presence, and partnership with the team. [18]

Marking foci

• Empathic, plain-language communication [18]
• Accurate description of current management and rationale [6] [8]
• Honest probabilistic prognostic counselling [20]
• Engagement of parents in family-integrated care [18]
• Clear discharge and follow-up pathway [11] [12]