Discharge of late preterm infant Flashcards
What is the definition of late preterm infant?
34 35 36 WK GA
What percentage of births are late preterm?
What is the trend over time?
5.9%
Increasing - maybe secondary to increase in multiple pregnancies, obstetric interventions and improved accuracy of GA measurements
Why are these babies born early?
Preterm labour (80%) Obstetrical intervention (20%)
Why do we consider late preterm babies uniquely?
Because there is an increased risk of death (4.5 x higher than a term infant) and higher rates of CP (3x) and developmental delay (1.25 x).
WHY death: asphyxia (3.3x), infection (5x), SIDS (1.9x)
What are the physiological differences in late preterm infants?
Impaired thermoregulation
Immature and weak suck and swallow
Incomplete adaptation of certain enzyme systems
Poor immunological and respiratory defence system
What might late preterm infants struggle with at birth?
Poort thermal, metabolic and cardiovascular adaptation. May struggle with feeding.
May need to be observed in NICU with special attention to thermal environment and special help with lactation.
If the baby is doing great but mom is recovering from a CS, can we discharge the baby?
No, we need to observe establishment of good feeding. This is especially important for moms who had interventions such as CS
Who is more likely to be readmitted: 34, 35 or 36 wks GA?
Overall late pretermers are more likely to require readmission.
36 weeker > 34, 35.
WHY: ? maybe secondary to being discharged too early.
What are the recommendations at birth for kids who are potentially late preterm?
Document GA
Evaluate for succesful adaptation - T, vitals and BG at 2 hours of life.
Monitor for CVS stability and feeding - this can be done with mom.
Wrap infants and measure core temperature. Do not bathe until they can regulate.
Early feeding
What are the common reasons late pretermers are readmitted?
Hyperbili Feeding Apnea ALTE Sepsis Res problems Hypothermia
What is unique about their bill problems?
The bill levels peak later - at 7 days instead of 5
The bili stays elevated longer
The bili is higher (often by 4.5 days it reaches a significant peak)
Higher risk of kernicterus - the risk of extreme hyperbili doubles for every week of GA shorter than 40. This is especially true if breast fed (6x)
SO: late preterm infants who score in or above low-intermediate zone must be re-evaluated at 24-48 hours. If high risk, they must be observed throughout the first week of life.
IF the baby is doing great but mom is recovering from a CS, can we discharge the baby?
No, we need to observe establishment of good feeding. This is especially important for moms who had interventions such as CS
Who is more likely to be readmitted: 34, 35 or 36 wks GA?
Overall late pretermers are more likely to require readmission.
36 seekers > 34, 35.
WHY: ? maybe secondary to being discharged too early.
So what do we do about Bili in late pretermers?
Assess within 48 hours
Late preterm infants who score in or above low-intermediate zone must be re-evaluated at 24-48 hours.
If high risk, they must be observed throughout the first week of life.
Monitor weight/feeding within first 10 days of life.
What are the recommendations around feeding?
- need 24 hours of good feeding before DC
- Feeding
Is apnea of prematurity a common cause of SIDS for late pretermers?
Apnea is more common in late preterm, as is SIDS. BUT SIDS is not a prolongation of apnea of prematurity and typically occurs
What are the CPS recommendations around apnea of prematurity in this population?
34 wakers may be observed for a period of CVS monitoring
If an infant has apnea, they should be evaluated for a cause. If there is no cause, they should be monitored until they are 8 days apnea free.
If a late pretermer is born, looks good, but GBS status unknown and no IPA, what do you do?
Why?
observe x 24 hours
CBC
Why: they are at increased risk of GBS sepsis, both early and late
When these kids are home, what advise can you give parents regarding avoiding infection and why?
Wash hands.
Avoid ppl with URTI
WHY: high risk for sepsis and this extends beyond discharge.
Why is thermoregulation more of an issue for these kids?
Large surface area to weight
Impaired ability to shiver
What are the CPS recommendations re sugar and temperature?
Routine blood sugar monitoring
Keep home warm (18C) and do not use excessive clothing or bedding.
What follow up should a late pretermer have?
Within 48 hours as a minimum
