Safe dc of the late preterm infant (June 5, 2018)

Question 1

In what population does severe late hyperbilirubinemia occur (late prem)

Answer 1

Breastfeeding late preterm infants

Question 2

What days of age does severe late hyperbilirbuinemia occur in late prems?

Answer 2

4 or 5 of life

Question 3

what weeks of GA count as late preterm? (what are those corresponding days?)

Answer 3

34, 35 and 36 weeks of life. 238 - 258 days of gestation

Question 4

Is the number of late preterm deliveries increasing or decreasing over time?

Answer 4

increasing (of multiple gestation, intervention, and improved accuracy of measurement).

Question 5

Mortality and morbidity in late preterm infants ______ rapidly as GA ____

Answer 5

M&M increases rapidly as GA decreases

Question 6

Mortality is 4.5x higher than that of term babies in what year?

Answer 6

1992- 1994

Question 7

What are 5 commong physiological problems late preterms have?

Answer 7

Inadequate thermoregulation, immature and weak suck and swallow patterns, incomplete adaptation of certain enzyme systems and poor immunological and respiratory defense

Question 8

Rates of cerebral palsy are ___ x higher in late preterms

Answer 8

3x higher rates of CP

Question 9

early school age outcomes show ____ risks of developmental delay and special needs attributable to shorter GA

Answer 9

modestly increased developmental delay

Question 10

infants identified as late prem should be observed and evaluated for ________, bg at ___h, and ___

Answer 10

Infants identified as late preterm should be observed and evaluated for core temperature, blood glucose at 2h, and vital signs.

Question 11

bathing should await the establishment of a core body temperature of at least ____

Answer 11

36.5 degrees (no bath until then)

Question 12

late preterms are particularly at risk for readmission with 1. _____, 2. feeding problems 3. _____, 4. sepsis (or suspected) 5. respiratory issues, 6. ______

Answer 12

Late prem at risk for readmission with; 1. Hyperbilirubinemia 2. Feeding problems 3. ALTE 4. Suspected sepsis 5. respiratory problems 6. hypothermia

Question 13

When do bili levels peak in late prems?

Answer 13

7 days (instead of 5 days)

Question 14

Bili levels in late prems stay elevated longer and ______

Answer 14

bili levels in late prems stay elevated longer and rach higher mean values (207 vs 190)

Question 15

T/F the late prem is at risk of kernicterus at lower levels of bilirubin than the term infant.

Answer 15

True

Question 16

Exclusive BF increases the risk of extreme hyperbili by approximately ____x

Answer 16

6x.

Question 17

what is the extreme hyperbili level that has been used as a surrogate for kernicterus risk? and what number of newborns exceeded this threshold?

Answer 17

428umol/L and 1.4/1000 newborns exceeeded the threshold

Question 18

late preterm infants who score in or above the low intermediate zone must be re evaluated within ___

Answer 18

24 - 48h

Question 19

the median age at which infants with extreme hyperbili were reported to have reached or exceeded 428umol/L was ____d

Answer 19

4.5d

Question 20

Late preterm infants must have an assessment of their serum bilirubin levels within ___h

Answer 20

48h

Question 21

Late preterm infants should be assessed for feeding, weight gain, and jaundice repeatedly int he first __d of life until consistent ____ without ____ is established

Answer 21

first 10d of life until consistnet weight gain without jaundice

Question 22

___ h of successful feeding of late preterm infants ust be established before d/c

Answer 22

24h of feeding

Question 23

families should have ____ experience prior to discharge

Answer 23

care by parent

Question 24

individual feedings shuld not exceed ___ min in length

Answer 24

20 min

Question 25

feeding and prep for feeding should not take more than ____h of the day at d/c

Answer 25

6h. feeding and prep for feeding should not take more than 6h of the day at d/c

Question 26

early weight loss should not exceed ____% of the body

Answer 26

10%

Question 27

Apnea of prematurity falls with _____ _____ ____ form 30 - 37 weeks

Answer 27

increasing brain maturation

Question 28

Late pretern infants of 34 weeks GA may be considered for _______ ______ in the NICU prior to transfer to a low risk nursery

Answer 28

cardioresp monitoring

Question 29

If apnea of prematurity is diagnosed, infants shuld recieve cardioresp monitoring in a NICU until they have achieved ___ days of freedom from apnea

Answer 29

8 days

Question 30

Late preterns of less than ____ wks GA should be considered at risk for infection

Answer 30

36wks

Question 31

those less than 36wks GA are considered at risk, and in absence of known maternal status and intrapartum abx prophylaxis should have a ____ and __h of q4h observation

Answer 31

CBC and 24h of q4h obs

Question 32

what are two things that cause temperature instability in the late preterm?

Answer 32

1. large surface area to weight 2. reduced capacity for thermogenesis

Question 33

a follow up provider within ___h of discharge should be arranged with a communtiy based care provider prior to dc

Answer 33

48h