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LATE PRETERM AND EARLY TERM INFANTS. Hugo A. Navarro, M.D. Medical Director SCN Alamance Regional Medical Center Assistant Professor DUMC. Goals. Increase awareness of vulnerability in late preterm and early term infants Definition and incidence Discuss physiologic limitations - PowerPoint PPT Presentation
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Hugo A. Navarro, M.D.Medical Director
SCN Alamance Regional Medical CenterAssistant Professor DUMC
GoalsIncrease awareness of vulnerability in late preterm and
early term infantsDefinition and incidenceDiscuss physiologic limitationsMorbidity and Mortality
Questions
Incidence of early term birth
Births of infants > 40 weeks gestation has declined, whereas the early term infants has increased
Approximately 700,000 births/year in USA (17.5% of live births) occur 37 0/7-38 6/7 weeks of gestation
Why?
Is multifactorial: Increased surveillance and medical interventions Inaccurate gestational age estimatesPresumption of fetal maturity at 34 weeks’ gestationChanges in maternal demographics and health
Why?
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
Willingness of mothers to incur risk on behalf of their child
The ↑ in LPT and ET, raisesthe risk for physiologically
immature infants
↑risk for medical complications
that result in higher morbidityand mortality during birth
hospitalization
↑admissions to NICU and duration of hospital stay,
disrupting the infant-family bonding
↑ rates of readmission duringthe neonatal period
↑long-term complications
Most common problems/treatments in descending order
Feeding problems Respiratory distress Evaluation for sepsis
Intravenous fluids Jaundice
HypoglycemiaTemperature instability
Apnea Mechanical ventilation
POOR FEEDERLower the GA worst the feeding skills
Dehydration Hypoglycemia
Hyperthermia Hyperbilirubinemia
IV fluidsAntibiotics
Phototherapy
ADMISSION
Summary LPT and ET infants are at greater risk than term infants
for acute and long-term complications of premature birthThe rates of LPT and ET births are increasingCauses for the increase in rates of LPT and ET infants are
unclearThe route and timing of delivery of LPT and ET NB infants
have important implications for short-term and long-term neonatal outcomes
Summary The risks and benefits for planned induction of labor, or
elective cesarean section for mother and infant should be carefully considered by mothers, families, and physicians when determining the optimal timing and route of delivery
Our understanding of the maternal, fetal, neonatal, and long-term outcomes and causes of LPT and ET births is incomplete
Summary
Research is needed to increase our understanding of maternal and infant outcomes of infants born at 34 to 38 weeks’ gestation, to determine the efficacy and safety of strategies to optimize these outcomes, and to develop interventions that effect physiologic maturation of the fetus when premature delivery is necessary or elective
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