The Old Man and the Earthquake, a story for entertainment
Care of late preterm infant sandip
1. CARE OF LATE PRETERM
INFANT
SANDIP
GUPTA
PGT
,PEDIATRICS
2.
3.
4. • Is multifactorial:
• Increased surveillance and medical interventions
• Inaccurate gestational age estimates
• Presumption of fetal maturity at 34 weeks’ gestation
• ART
• Increased rates of elective cesarean sections and
inductions of labor
• Maternal and physician concerns about complications
of vaginal delivery and subtle changes in medical
thresholds for cesarean birth
7. RESPIRATORY
• Late preterm infants: 28.9% respiratory
distress at birth compared to 4.2% of term
infants.
• It was found that for incidence of respiratory
distress increases with every week less than
39 wk,
• 30/1000 @34 wks to 14/1000@35wks
to7.1/1000 @36 wks.
9. GI SYSTEM: NUTRITION
Feeding problems: neuronal immaturity,
decreased oromotor tone, sleepier,have less
stamina.
Nutritional experts recommend 34-35 wks LPT
receive nutrient rich milk(22kcal/oz) with higher
protein(1.9g/dl),calcium, phosphate, Zn,trace
elements ,vitamins.
TPN: more adept to handle aminiacids( start @
2g/kg/d maintain @ 2.5-3g/kg/d).
Use of lipids in LPT infants to prevent essential
fatty acid deficiency in infants with increased
PVR& respiratory disease should be avoided in
critical stages of illness.
10. HYPOGLYCEMIA
Often missed, occurs 3times more .
Decreased glycogen storage & feeding
difficulty,compensatory mechanism not fully
developed.
Severe hypoglycemia is a risk factor for neuronal
cell death
&
poor neurodevelopmental outcomes.
Routine testing of bl.sugar in LPT infant.
Glucose requirement 6-8mg/kg/hr.
Demand may increase in coexisting sepsis,
asphyxia ,cold stress.
11. HYPERBILIRUBINEMIA
Most common condition requiring evaluation,t/t,
readmission.
Rehospitalisation for jaundice higher in preterms(4.5%
vs 1.2% in terms.
Newman et al(1999) in their study showed that neonates
born at 36wks have 8 times more risk of TSB>20mg%
when compared to those born at 41wks or later.
Hepatic immaturity& overall immaturity of GUT function
& motility.
LPT are at a greater risk of kernicterus at bilirubin level
equal to or lower than that of a term baby.
AAP recommends that all newborns should be assessed
for risk of developing hyprbilirubinemia by using
predischarge TSB or TCB
12. INFECTIONS
More susceptibility to infection due to
immunological immaturity.
Congenital, Early & Late .
Research shows that LPT undergo testing for
sepsis more often than term infants(36.7%12.6%)& receive antibiotics more often & for a
longer duration.
This may be because 1/3rd of preterm deliveries
occur due to PPROM, as well as due to their
presentation with respiratory distress,
hypoglycemia ,hypothermia.
13. THERMOREGULATION
Manifests as tachypnea,apnea, poor feeding,poor
color,& metabolic acidosis.
Hypothermia can respiratory transition
exacerbate hypoglycemia which can mimick
sepsis.
Physiological immaturity of thermoregulation
:brown & white adipose tissue, body surface area.
LPT have decrease hormone for brown fat
meatabolism(prolactin,norepinephrin,T3,cortisol).
14. NEURODEVELOPMENT
Research shows that LPTs & early term neonates
have risk for development through 1st 5yrs of life.
During final few wks brain maturity is still in
progress.
These aspects include maturing
oligodendroglia,neuronal arborisation,
connectivity, maturation of neurotransmitter
system & accounts for 30% of brain growth in
last few weeks.
brain of LPT still immature , the cerebral cortex
still smooth sulci& gyri are not fully
formed,myelination & neuronal connectivity is still
incomplete.
15. HOSPITALISATION
ADMISSION CRITERION:It is recommended that
all newborns born before 35wks& or having birth
wt<2300gm should be admitted to atransitional
nursery & should be monitored for vitals,feeding
abilities, thermoregulation & other problems.
HOSPITAL MANAGEMENT:
Physical exam
Gestational age estimation
Vitals monitoring & pulse oximetry
Feeding plan & assessment of breastfeeding.
Scrrening for hypoglycemia & tcb.
16. DISCHARGE CRITERIA
Should not be discharged before 48hrs
Vitals normal for 12hrs before discharge.
Passage of 1 stool spontaneously.
Adequate urine output.
24hrs of successful breastfeeding.
Wtloss >7% in 48hrs should be assesed further
before discharge.
Risk assessment plan for infant discharged
before72 hrs.
17. FOLLOW UP
Brought back to their pediatrcian for a checkup.
Growth monitoring & developmental assessment.
Early intervention.
Hinweis der Redaktion
Until recently, we have classified infants by GA in : Preterm, Term and post-term, however due to difference in their physiology, development, morbidity, mortality and long term outcome, we are using a new terminology to describe the GA: preterm, LPT, ET and term.
Why there has been an increase in this 2 groups? We really don’t know, but it seems to be multifactorial.