LATE PRETERM DELIVERY 34 0/7 – 36 6/7 WEEKS DECEMBER 2010
LATE PRETERM DELIVERY NEONATAL MORBIDITY <ul><li>During the initial birth hospitalization, late preterm infants are 4 time...
LATE PRETERM DELIVERY MORBIDITY INCREASED WITH   MATERNAL COMPLICATIONS <ul><li>This risk for neonatal morbidity rises eve...
LATE PRETERM DELIVERY READMISSION AFTER DISCHARGE <ul><li>Readmission rates are two to three times greater for late preter...
LATE PRETERM DELIVERY INFANT MORTALITY <ul><li>The infant mortality rate (</= to 1 year) is higher among late-preterm infa...
LATE PRETERM DELIVERY LONG TERM OUTCOME <ul><li>Increased risk for long-term neurodevelopmental morbidity  </li></ul><ul><...
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Late preterm delivery

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Late preterm delivery

  1. 1. LATE PRETERM DELIVERY 34 0/7 – 36 6/7 WEEKS DECEMBER 2010
  2. 2. LATE PRETERM DELIVERY NEONATAL MORBIDITY <ul><li>During the initial birth hospitalization, late preterm infants are 4 times more likely than term infants to have at least 1 medical condition diagnosed and 3.5 times more likely to have 2 or more conditions diagnosed than term infants. </li></ul><ul><li>During the initial birth hospitalization, late preterm infants compared to term infants are more likely to have the following Morbidities: </li></ul><ul><li>Temperature instability </li></ul><ul><li>Hypoglycemia </li></ul><ul><li>Respiratory distress </li></ul><ul><li>Apnea </li></ul><ul><li>Hyperbilirubinemia </li></ul><ul><li>Feeding difficulties </li></ul>AAP LATE PRETERM DELIVERY Pediatrics. 2007;120(6):1390-401 ACOG LATE PRETERM DELIVERY Number 404 • April 2008
  3. 3. LATE PRETERM DELIVERY MORBIDITY INCREASED WITH MATERNAL COMPLICATIONS <ul><li>This risk for neonatal morbidity rises even higher in infants delivered of mothers with additional Ob/Medical complications . </li></ul><ul><li>Neonatal Morbidity rates are higher in late preterm infants whose mothers had maternal hypertension, diabetes, antepartum hemorrhage, and infections . </li></ul><ul><li>The neonatal morbidity risk increased disproportionately higher than the expected neonatal morbidity for a given EGA. As an example ,a 12-fold increase in neonatal morbidity is associated with antepartum hemorrhage in late preterm infants which is greater than the expected EGA specific morbidity . </li></ul><ul><li>Neonatal Morbidity rates increased with each additional maternal Ob or Medical complication </li></ul><ul><li>18 % with one maternal risk factor </li></ul><ul><li>29 % with two maternal risk factors </li></ul><ul><li>37 % with three maternal risk factors </li></ul>Pediatrics. 2008;121(2):e223-32.
  4. 4. LATE PRETERM DELIVERY READMISSION AFTER DISCHARGE <ul><li>Readmission rates are two to three times greater for late preterm compared to term infants. </li></ul><ul><li>Two Large Cohorts of late preterm deliveries demonstrated readmission rates over the first year of life were ~ 15% </li></ul><ul><li>Specifically, Late preterm infants are three times more likely to be admitted within the first 15 days after discharge from the birth hospitalization ( 3.8 vs 1.3 %) . The most common reasons for early readmission are jaundice, feeding difficulties, poor weight gain, dehydration, and apnea . </li></ul><ul><li>Respiratory and gastrointestinal disorders are the most common diagnoses for late readmission (≥15 days after the date of discharge) during the first year of life. </li></ul>Pediatrics. 2009;123(2):653-9 J Perinatol. 2007;27(10):614-9
  5. 5. LATE PRETERM DELIVERY INFANT MORTALITY <ul><li>The infant mortality rate (</= to 1 year) is higher among late-preterm infants than term infants. </li></ul><ul><li>7.7 / 1000 live births (0.8%) vs 2.5 / 1000 live births (0.25%) </li></ul><ul><li>This threefold increase in mortality has remained relatively constant since 1995, at which time the infant mortality rate was 9.3 per 1000 live births among late-preterm infants and 3.1 per 1000 live births among term infants. </li></ul>AAP LATE PRETERM DELIVERY Pediatrics. 2007;120(6):1390-401
  6. 6. LATE PRETERM DELIVERY LONG TERM OUTCOME <ul><li>Increased risk for long-term neurodevelopmental morbidity </li></ul><ul><li>Comparing late-preterm infants with term infants observational studies demonstrate a higher risk of </li></ul><ul><li>Neurodevelopmental handicaps ie.. </li></ul><ul><li>(mental retardation and developmental delay) </li></ul><ul><li>Cerebral palsy (RR 3.39; 95% CI, 2.54-4.52) </li></ul><ul><li>Behavioral abnormalities : </li></ul><ul><li>scholastic, social, psychological development </li></ul><ul><li>and behavioral difficulty (RR 1.5; 95% CI 1.2-1.8) </li></ul><ul><li>Speech disorders </li></ul><ul><li>AAP LATE PRETERM DELIVERY Pediatrics. 2007;120(6):1390-401 </li></ul>J Pediatr. 2009;154(2):169-76 N Engl J Med. 2008;359(3):262-73.
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