Care of late preterm

1. CARE OF LATE PRETERM
INFANT
SANDIP
GUPTA
PGT
,PEDIATRICS

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

5. COMMON PROBLEMS
 Temprature instability
 Hypoglycemia
 Respiratory distress
 Apnea
 Jaundice
 Feeding difficulty
 Dehydration
 Suspected sepsis

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.

8. CAUSES
 TTN
 RDS
 PPHN
 APNEA

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
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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,
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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
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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.