Until recently, we have classified infants by GA in : Preterm, Term and post-term, however due to difference in their physiology, development, morbidity, mortality and long term outcome, we are using a new terminology to describe the GA: preterm, LPT, ET and term.
Why there has been an increase in this 2 groups? We really don’t know, but it seems to be multifactorial.
Care of late preterm infant sandip
CARE OF LATE PRETERM
• Is multifactorial:
• Increased surveillance and medical interventions
• Inaccurate gestational age estimates
• Presumption of fetal maturity at 34 weeks’ gestation
• Increased rates of elective cesarean sections and
inductions of labor
• Maternal and physician concerns about complications
of vaginal delivery and subtle changes in medical
thresholds for cesarean birth
• Late preterm infants: 28.9% respiratory
distress at birth compared to 4.2% of term
• It was found that for incidence of respiratory
distress increases with every week less than
• 30/1000 @34 wks to 14/1000@35wks
to7.1/1000 @36 wks.
GI SYSTEM: NUTRITION
Feeding problems: neuronal immaturity,
decreased oromotor tone, sleepier,have less
Nutritional experts recommend 34-35 wks LPT
receive nutrient rich milk(22kcal/oz) with higher
protein(1.9g/dl),calcium, phosphate, Zn,trace
TPN: more adept to handle aminiacids( start @
2g/kg/d maintain @ 2.5-3g/kg/d).
Use of lipids in LPT infants to prevent essential
fatty acid deficiency in infants with increased
PVR& respiratory disease should be avoided in
critical stages of illness.
Often missed, occurs 3times more .
Decreased glycogen storage & feeding
difficulty,compensatory mechanism not fully
Severe hypoglycemia is a risk factor for neuronal
poor neurodevelopmental outcomes.
Routine testing of bl.sugar in LPT infant.
Glucose requirement 6-8mg/kg/hr.
Demand may increase in coexisting sepsis,
asphyxia ,cold stress.
Most common condition requiring evaluation,t/t,
Rehospitalisation for jaundice higher in preterms(4.5%
vs 1.2% in terms.
Newman et al(1999) in their study showed that neonates
born at 36wks have 8 times more risk of TSB>20mg%
when compared to those born at 41wks or later.
Hepatic immaturity& overall immaturity of GUT function
LPT are at a greater risk of kernicterus at bilirubin level
equal to or lower than that of a term baby.
AAP recommends that all newborns should be assessed
for risk of developing hyprbilirubinemia by using
predischarge TSB or TCB
More susceptibility to infection due to
Congenital, Early & Late .
Research shows that LPT undergo testing for
sepsis more often than term infants(36.7%12.6%)& receive antibiotics more often & for a
This may be because 1/3rd of preterm deliveries
occur due to PPROM, as well as due to their
presentation with respiratory distress,
Manifests as tachypnea,apnea, poor feeding,poor
color,& metabolic acidosis.
Hypothermia can respiratory transition
exacerbate hypoglycemia which can mimick
Physiological immaturity of thermoregulation
:brown & white adipose tissue, body surface area.
LPT have decrease hormone for brown fat
Research shows that LPTs & early term neonates
have risk for development through 1st 5yrs of life.
During final few wks brain maturity is still in
These aspects include maturing
connectivity, maturation of neurotransmitter
system & accounts for 30% of brain growth in
last few weeks.
brain of LPT still immature , the cerebral cortex
still smooth sulci& gyri are not fully
formed,myelination & neuronal connectivity is still
ADMISSION CRITERION:It is recommended that
all newborns born before 35wks& or having birth
wt<2300gm should be admitted to atransitional
nursery & should be monitored for vitals,feeding
abilities, thermoregulation & other problems.
Gestational age estimation
Vitals monitoring & pulse oximetry
Feeding plan & assessment of breastfeeding.
Scrrening for hypoglycemia & tcb.
Should not be discharged before 48hrs
Vitals normal for 12hrs before discharge.
Passage of 1 stool spontaneously.
Adequate urine output.
24hrs of successful breastfeeding.
Wtloss >7% in 48hrs should be assesed further
Risk assessment plan for infant discharged
Brought back to their pediatrcian for a checkup.
Growth monitoring & developmental assessment.