Safe dc of the late preterm infant (June 5, 2018) Flashcards
In what population does severe late hyperbilirubinemia occur (late prem)
Breastfeeding late preterm infants
What days of age does severe late hyperbilirbuinemia occur in late prems?
4 or 5 of life
what weeks of GA count as late preterm? (what are those corresponding days?)
34, 35 and 36 weeks of life. 238 - 258 days of gestation
Is the number of late preterm deliveries increasing or decreasing over time?
increasing (of multiple gestation, intervention, and improved accuracy of measurement).
Mortality and morbidity in late preterm infants ______ rapidly as GA ____
M&M increases rapidly as GA decreases
Mortality is 4.5x higher than that of term babies in what year?
1992- 1994
What are 5 commong physiological problems late preterms have?
Inadequate thermoregulation, immature and weak suck and swallow patterns, incomplete adaptation of certain enzyme systems and poor immunological and respiratory defense
Rates of cerebral palsy are ___ x higher in late preterms
3x higher rates of CP
early school age outcomes show ____ risks of developmental delay and special needs attributable to shorter GA
modestly increased developmental delay
infants identified as late prem should be observed and evaluated for ________, bg at ___h, and ___
Infants identified as late preterm should be observed and evaluated for core temperature, blood glucose at 2h, and vital signs.
bathing should await the establishment of a core body temperature of at least ____
36.5 degrees (no bath until then)
late preterms are particularly at risk for readmission with 1. _____, 2. feeding problems 3. _____, 4. sepsis (or suspected) 5. respiratory issues, 6. ______
Late prem at risk for readmission with; 1. Hyperbilirubinemia 2. Feeding problems 3. ALTE 4. Suspected sepsis 5. respiratory problems 6. hypothermia
When do bili levels peak in late prems?
7 days (instead of 5 days)
Bili levels in late prems stay elevated longer and ______
bili levels in late prems stay elevated longer and rach higher mean values (207 vs 190)
T/F the late prem is at risk of kernicterus at lower levels of bilirubin than the term infant.
True
Exclusive BF increases the risk of extreme hyperbili by approximately ____x
6x.
what is the extreme hyperbili level that has been used as a surrogate for kernicterus risk? and what number of newborns exceeded this threshold?
428umol/L and 1.4/1000 newborns exceeeded the threshold
late preterm infants who score in or above the low intermediate zone must be re evaluated within ___
24 - 48h
the median age at which infants with extreme hyperbili were reported to have reached or exceeded 428umol/L was ____d
4.5d
Late preterm infants must have an assessment of their serum bilirubin levels within ___h
48h
Late preterm infants should be assessed for feeding, weight gain, and jaundice repeatedly int he first __d of life until consistent ____ without ____ is established
first 10d of life until consistnet weight gain without jaundice
___ h of successful feeding of late preterm infants ust be established before d/c
24h of feeding
families should have ____ experience prior to discharge
care by parent
individual feedings shuld not exceed ___ min in length
20 min
feeding and prep for feeding should not take more than ____h of the day at d/c
6h. feeding and prep for feeding should not take more than 6h of the day at d/c
early weight loss should not exceed ____% of the body
10%
Apnea of prematurity falls with _____ _____ ____ form 30 - 37 weeks
increasing brain maturation
Late pretern infants of 34 weeks GA may be considered for _______ ______ in the NICU prior to transfer to a low risk nursery
cardioresp monitoring
If apnea of prematurity is diagnosed, infants shuld recieve cardioresp monitoring in a NICU until they have achieved ___ days of freedom from apnea
8 days
Late preterns of less than ____ wks GA should be considered at risk for infection
36wks
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
CBC and 24h of q4h obs
what are two things that cause temperature instability in the late preterm?
- large surface area to weight 2. reduced capacity for thermogenesis
a follow up provider within ___h of discharge should be arranged with a communtiy based care provider prior to dc
48h
