The Late Preterm Infant

DID YOU KNOW THAT OVER 70% OF ALL PRETERM BIRTHS ARE INFANTS BORN IN THE LATE PRETERM AGE GROUP?

The Late Preterm Infant The Late Preterm (LPT) Infant is defined as any baby born between 34.0 and 36.6 weeks gestation. While LPT infants may appear much like their full term counterparts, there is a reason they have earned the label “the great imposters”. 30-40% of LPT infants are admitted to the NICU. Common conditions that require admission to the NICU for the LPT infant are: hypoglycemia, hypothermia, hyperbilirubinemia, poor feeding, and respiratory distress syndrome.

Admission Guidelines LPT infants born at 34.0-34.6 weeks gestation warrant an immediate NICU admission. LPT infants born at 35.0-36.6 weeks gestation are sometimes given a trial of standard care in the newborn nursery.

Care Guidelines for LPT Infants 35 0/7-36 6/7 Weeks Gestation Breathing /Development/Temperature After delivery, if not in distress, allow baby to remain skin to skin with mother for up to 45 minutes. May breastfeed if not experiencing respiratory distress. Place pulse oximetry on baby during this time. Assess vital signs Q 3-4 hours during the first 24 hours of life. If stable, may assess vital signs Q 6-8 hours. 1st temp by 45 minutes of life, then again by 2 hours of age. Wean to crib as tolerates. Delay bath until infant has 2 consecutive stable temperatures. Do not bathe the infant until 4 hours of age. WAIT to perform first bath until the mother is able to participate.

Care Guidelines for LPT Infants 35 0/7-36 6/7 Weeks Gestation Blood Glucose Stable glucose, breast or bottle feeding, no IV Facilitate feeding within the 1st hour of life. Check a glucose 30 minutes after completion of feeding. Follow the AAP Late Preterm Glucose Protocol.

Screening for and management of postnatal glucose homeostasis in late-preterm (LPT 34–36 6/7 weeks) and term small-for-gestational age (SGA) infants and infants who were born to mothers with diabetes (IDM)/large-for-gestational age (LGA) infants. Screening for and management of postnatal glucose homeostasis in late-preterm (LPT 34–3667 weeks) and term small-for-gestational age (SGA) infants and infants who were born to mothers with diabetes (IDM)/large-for-gestational age (LGA) infants. LPT and SGA (screen 0–24 hours), IDM and LGA ≥34 weeks (screen 0–12 hours). IV indicates intravenous. Committee on Fetus and Newborn Pediatrics 2011;127:575-579 ©2011 by American Academy of Pediatrics

Care Guidelines for LPT Infants 35 0/7-36 6/7 Weeks Gestation Blood Glucose Symptomatic and/or has running IV fluids At a minimum, check blood glucoses at the following intervals: 1 hour of life 6 hours of life With AM lab draw Follow the AAP Late Preterm Glucose Protocol.

Care Guidelines for LPT Infants 35 0/7-36 6/7 Weeks Gestation Feeding Promote Kangaroo Care Allow first feeding within 1st hour of life, if not experiencing respiratory distress. Breast Feeding Consult lactation consultant. Ad lib feedings Q 2-3 hours with goal of 8-10 feedings per day. Mother needs to pump after nursing to facilitate breast emptying. If weight loss > 3% per day or total of 7% below birth weight, consider supplementing after breast feeding with mother’s expressed breast milk, formula or donor expressed breast milk. Formula Feeding Feed Q 2-4 hours with goal of 8 feedings in 24 hours

Care Guidelines for LPT Infants 35 0/7-36 6/7 Weeks Gestation Jaundice Two transcutaneous bilirubin (TC Bili) checks need to be performed prior to discharge-ideally at 24 and 48 hours of life. If TC bilimeter not available, collect bilirubin level with Newborn Screen or when clinical jaundice is noted. Educate parents that the LPT infant’s bilirubin level peaks at 5-7 days, thus it is important to follow up with their Primary Care Provider if infant is discharged prior to 5 days.

Care Guidelines for LPT Infants 35 0/7-36 6/7 Weeks Gestation Infection Evaluate for early neonatal sepsis (presence of maternal chorio as well as maternal GBS status). Utilize the Neonatal Early Onset Sepsis Calculator to risk stratify the infant https://neonatalsepsiscalculator.kaiserpermanente.org/. Educate parents on S/S of infection: jaundice, fussiness, fatigue, unstable temperatures, poor feeding, frequent vomiting. Emphasize the importance of good hand hygiene to parents, family and visitors.

Care Guidelines for LPT Infants 35 0/7-36 6/7 Weeks Gestation Discharge Discharge checklist: Back to sleep education Hearing screen (if on Gentamicin, perform hearing screen after last dose) Car seat/angle tolerance study Congenital heart disease screen Follow up appointment with PCP made prior to discharge

Care Guidelines for LPT Infants 35 0/7-36 6/7 Weeks Gestation Developmental Follow Up LPT infants are at increased risk for developmental delays in comparison to their full term counterparts. It is important to closely follow the LPT infant’s neurodevelopment and intervene as needed. NICU based Developmental Follow Up Clinic Early Development Network

References Multidisciplinary Guidelines for the Care of Late Preterm Infants-National Perinatal Association Assessment and Care of the Late Preterm Infant Implementation Tool Kit-AWHONN Agency for Healthcare Research and Quality-Assessment and care of the late preterm infant. Evidence-based clinical practice guideline. McGowan JE, Alderdice FA, Holmes VA, Johnston L. Early childhood development of late- preterm infants: a systematic review. Pediatrics 2011; 127:1111-24