1. CARE OF LATE PRETERM INFANT SANDIP GUPTA PGT ,PEDIATRICS

2. Is multifactorial: Increased surveillance and medical interventions Inaccurate gestational age estimates Presumption of fetal maturity at 34 weeks gestation ART Increased rates of elective cesarean sections andinductions of labor Maternal and physician concerns about complications of vaginal delivery and subtle changes in medical thresholds for cesarean birth 3. COMMON PROBLEMS Temprature instability Hypoglycemia Respiratory distress Apnea Jaundice Feeding difficulty Dehydration Suspected sepsis 4. RESPIRATORY Late preterm infants: 28.9% respiratorydistress at birth compared to 4.2% of term infants. It was found that for incidence of respiratory distress increases with every week less than 39 wk, 30/1000 @34 wks to 14/1000@35wks to7.1/1000 @36 wks. 5. CAUSES TTN RDS PPHN APNEA 6. GI SYSTEM: NUTRITION Feeding problems: neuronal immaturity,decreased oromotor tone, sleepier,have less stamina. Nutritional experts recommend 34-35 wks LPT receive nutrient rich milk(22kcal/oz) with higher protein(1.9g/dl),calcium, phosphate, Zn,trace elements ,vitamins. 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. 7. HYPOGLYCEMIA Often missed, occurs 3times more . Decreased glycogen storage & feeding difficulty,compensatory mechanism not fully developed. Severe hypoglycemia is a risk factor for neuronal cell death & 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. 8. HYPERBILIRUBINEMIA Most common condition requiring evaluation,t/t, readmission. 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 & motility. 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 9. INFECTIONS More susceptibility to infection due toimmunological immaturity. 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 longer duration. This may be because 1/3rd of preterm deliveries occur due to PPROM, as well as due to their presentation with respiratory distress, hypoglycemia ,hypothermia. 10. THERMOREGULATION Manifests as tachypnea,apnea, poor feeding,poorcolor,& metabolic acidosis. Hypothermia can respiratory transition exacerbate hypoglycemia which can mimick sepsis. Physiological immaturity of thermoregulation :brown & white adipose tissue, body surface area. LPT have decrease hormone for brown fat meatabolism(prolactin,norepinephrin,T3,cortisol). 11. NEURODEVELOPMENT Research shows that LPTs & early term neonateshave risk for development through 1st 5yrs of life. During final few wks brain maturity is still in progress. These aspects include maturing oligodendroglia,neuronal arborisation, 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 incomplete. 12. HOSPITALISATION ADMISSION CRITERION:It is recommended that all newborns born before 35wks& or having birth wt7% in 48hrs should be assesed furtherbefore discharge. Risk assessment plan for infant discharged before72 hrs. 14. FOLLOW UP Brought back to their pediatrcian for a checkup. Growth monitoring & developmental assessment. Early intervention.