Safe Discharge Of Late Preterm Infant

Question 0

Why are late preterm births increasing?

Answer 0

More accurate GA estimates, more obstetrical intervention, more twins.

Question 1

What is a late-preterm? What is the rate of late preterm births?

Answer 1

34-36+6. About 6% of all births.

Question 2

What is the mortality rate of late preterm a vs term babies?

Answer 2

Based on number in 1990, 4.5x the mortality!

Question 3

What are 4 significant changes/deficits seen in late preterms vs term babies?

Answer 3

Immature enzymes.
Immature immune/respiratory defences.
Poor suck/swallow (difficult feeding).
Inadequate thermoregulation (these are all kinda discharge criteria!)

Question 4

Are long term outcomes any different in late preterm infants vs term?

Answer 4

Yes. Increased rates of MR, CP, and developmental delay. (3x!!)

Question 5

What are the recommendations for bathing, feeding, sugar testing in late preterms?

Answer 5

Await bathing until proven thermoregulation above 36.5. Check sugars 2 hrs after birth. Feeding trialled early. Cardio resp monitor.

Question 6

List 3 differences in hyperbilirubinemia in late preterm infants vs term infants.

Answer 6

1. Peaks at 7 days rather than 5 days.
2. Peak is higher.
3. Stays elevated longer.
4. Double risk for every week before term.

Question 7

In late preterm infants, when would you first check your bili? What is the interval for checking weight, jaundice?

Answer 7

Should do first bili at 48 hrs.

Then daily weights, assessments.

Question 8

How long do late prems have to feed well for before discharge home? What is the max duration of feed allowed?

Answer 8

At least 24 hrs. 20 min max feeding time.

Question 9

With late prems,how many hours in a day should be spent feeding/preparing to feed (max)?

Answer 9

6 hours.

Question 10

How apnea free days are recommended before discharge home of a late prem who had previous apnea of prematurity?

Answer 10

8 days! Should not give caffeine at home.

Question 11

At what GA do you start considering 8-12 hrs of observation in NICU before returning/going to low risk nursery?

Answer 11

34 weeks.

Question 12

Late prems <36 weeks are at increased risk for what type of infection?

Answer 12

GBS sepsis, and increased mortality vs term infants.

Question 13

With late prems, when should a follow up appointment be arranged?

Answer 13

Within 48 hours. Overall discharge should be flexible, and nor irreversible.