Safe discharge of the late preterm infant

Question 1

What is a late preterm?

Answer 1

34-36 weeks GA

Question 2

What morbidities are associated with late prematurity?

Answer 2

1. Death RR 4.5
2. Asphyxia RR 3.3
3. Infection RR 5.0
4. SIDS RR 1.9

Question 3

What other problems can lat preterm infants have?

Answer 3

1. Inadequate thermoregulation
2. Immature and weak suck and swallow pattern
3. Incomplete adaptation of certain enzyme systems
4. Poor immunological and respiratory defense systems

Question 4

What are recommendations regarding early care and assessment of late preterm infants?

Answer 4

1. All infants at birth must have a carefully documented assessment of GA.
2. Infants identified as late preterm should be carefully observed for successful adaptation. Evaluation should include core temperature, blood glucose at 2 h and vital signs.
3. Provision should be made for short-term observation of late preterm infants for cardiorespiratory stability and ability to feed before triage to either a low-risk or an intermediate/high-risk nursery.
4. Infants should be wrapped, and core temperatures measured and documented. Bathing should await the establishment of a core body temperature of at least 36.5°C.
5. Early feeding should be attempted.

Question 5

What postdischarge problems are of particular concern in late preterm infants?

Answer 5

1. Hyperbilirubinemia
2. Feeding problems
3. Apnea or ALTE
4. Suspected sepsis
5. Respiratory problems
6. Hypothermia

Question 6

What are the recommendations regarding late preterms and hyperbilirubinemia?

Answer 6

1. Late preterm infants must have an assessment of their serum bilirubin levels within 48 h of birth, and be evaluated using current guidelines for detection, management and prevention of hyperbilirubinemia for late preterm newborn infants.
2. Late preterm infants should be assessed for feeding, weight gain and jaundice repeatedly in the first 10 days of life consistent weight gain without jaundice has been established.

Question 7

What are the recommendations regarding late preterms and feeding difficulties?

Answer 7

1. Twenty-four hours of successful feeding of late preterm infants must be established before discharge home.
2. First-time mothers, in particular, require careful supervision and, when infants are leaving from an intensive care environment, should have a rooming-in experience.
3. Individual feedings should not exceed 20 min in length.
4. Feeding and preparation for feeding should not take more than 6 h of the day at discharge.
5. Discharge plans must take into account the health, parenting and feeding skills of the mother and the availability of support in the home.
6. Early weight loss should not exceed 10% of body weight.

Question 8

What are the recommendations regarding apnea, SIDS, and late preterm infants?

Answer 8

1. Late preterm infants of 34 weeks’ GA may be considered for a period of cardiorespiratory monitoring in a neonatal intensive care unit before transfer to a low-risk nursery.
2. Infants who manifest apnea require a diagnostic evaluation. If apnea of prematurity is diagnosed, infants should receive cardiorespiratory monitoring in a neonatal intensive care unit until they have achieved eight days of freedom from apnea.
3. Special care should be exercised to ensure that guidelines for the prevention of SIDS are followed in late preterm infants

Question 9

What are the recommendations regarding sepsis and later preterm infants?

Answer 9

1. Late preterm infants of less than 36 weeks’ GA should be considered at risk of infection and managed according to current guidelines for prevention of group B streptococcal infection.
2. Exposure to people with active upper respiratory tract infections or other viral infections should be avoided.
3. The benefits and techniques of hand washing in the prevention of infection should be taught on discharge.

Question 10

What are the recommendations regarding hypoglycemia and temperature control and late preterms?

Answer 10

1. Late preterm infants should have been demonstrated to be euglycemic before discharge.
2. The home environment must be adequately warm to support the infant’s thermal environment without recourse to excessive clothing or bedding.

Question 11

What are the recommendations regarding health services, discharge, and preterm infants?

Answer 11

1. Mother and infant separation at discharge should be avoided through the provision of flexible accommodation arrangements for parents.
2. A follow-up appointment within 48 h of discharge should be arranged with a community-based health care provider before the infant is discharged home.
3. Infant discharge should be flexible and reversible; provisions should be made to incorporate accessible community services into nurseries.