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