Late Preterm Birth:Late Preterm Birth:Late Preterm Birth: Late Preterm Birth: Increased Clinical RiskIncreased Clinical Risk

Given by Jodi Jackson, MDGiven by Jodi Jackson, MD

Slides adapted from previous presentations from Kristin Melton, Slides adapted from previous presentations from Kristin Melton, MD, and Martha Goodwin, NNPMD, and Martha Goodwin, NNP

Children’s Mercy Hospitals & Clinics, Kansas City, MOChildren’s Mercy Hospitals & Clinics, Kansas City, MO

A d D id S ili MDA d D id S ili MDAnd David Stamilio, MDAnd David Stamilio, MD

Washington University in St. LouisWashington University in St. Louis

Learning ObjectivesLearning ObjectivesLearning ObjectivesLearning Objectives

Appreciate late preterm babies as a particularly Appreciate late preterm babies as a particularly pp p p ypp p p yvulnerable population of infantsvulnerable population of infantsUnderstand the unique challenges that this Understand the unique challenges that this population facespopulation facespopulation facespopulation facesRecognize the increased risks associated with Recognize the increased risks associated with babies born in this populationbabies born in this populationp pp pUnderstand the trends in Kansas and the US Understand the trends in Kansas and the US regarding the birth of babies in the later preterm regarding the birth of babies in the later preterm periodperiodperiodperiodUnderstand some of the strategies used to promote Understand some of the strategies used to promote safe care of these infants, and avoidance of delivery safe care of these infants, and avoidance of delivery , y, ywhen possiblewhen possible

Late Preterm InfantsLate Preterm InfantsLate Preterm InfantsLate Preterm InfantsIt was recently recommended that the term “late It was recently recommended that the term “late preterm infants” replace the term “nearpreterm infants” replace the term “near--term infants ”term infants ”preterm infants replace the term nearpreterm infants replace the term near--term infants, term infants, as it better reflects the higher risk of complications as it better reflects the higher risk of complications experienced by this group of infantsexperienced by this group of infants

Late preterm infants (LPTI) are defined as premature Late preterm infants (LPTI) are defined as premature

infants born between 34 and 36 6/7 weeks of gestationinfants born between 34 and 36 6/7 weeks of gestation

First day of last menstrual period

Day 1 239 259 294

Late Preterm

274

Early Term

Week 0/71

P t P tT

36 6/734 0/7 41 0/738 6/7

ACOG Committee Opinion No. 404, 2008Engle WA et al Pediatrics 2007

Pre-term Pre-termTerm Post-Term

Why Focus on Late Preterm Infants?Why Focus on Late Preterm Infants?Why Focus on Late Preterm Infants?Why Focus on Late Preterm Infants?

The rates of prematurity in the United StatesThe rates of prematurity in the United StatesThe rates of prematurity in the United States The rates of prematurity in the United States continue to risecontinue to rise

In 2003, 12.3% of U.S. births were preterm, In 2003, 12.3% of U.S. births were preterm, , p ,, p ,representing a 16% increase since 1990 and a representing a 16% increase since 1990 and a 31% increase since 198131% increase since 1981

That means that That means that 1 in 8 babies1 in 8 babies is born is born premature in the United States premature in the United States Babies born between 34Babies born between 34--36 completed weeks 36 completed weeks account for account for 7171--74%74% of these preterm birthsof these preterm births

Why Focus on Late Preterm Why Focus on Late Preterm yyInfants?Infants?

Because they are mature in appearance, Because they are mature in appearance, usually weigh between 2usually weigh between 2--2.5 kg, are often 2.5 kg, are often relatively stable in the delivery room, and relatively stable in the delivery room, and these babies are often cared for in the wellthese babies are often cared for in the well--b bb bbaby nurserybaby nursery

However, recent evidence shows that the However, recent evidence shows that the late preterm infant faces a higher rate of late preterm infant faces a higher rate of morbidity (both early and late) and mortality morbidity (both early and late) and mortality h ih ithan its term counterpartthan its term counterpart

DefinitionsDefinitions

Intrauterine growth restriction (IUGR) Intrauterine growth restriction (IUGR) Rate of fetal growth less than normal or less than Rate of fetal growth less than normal or less than ggpotential for that infant. May not be SGApotential for that infant. May not be SGA

Low birth weight (LBW) Low birth weight (LBW) Birth weight less than 2500 gramsBirth weight less than 2500 grams

Very low birth weight (VLBW)Very low birth weight (VLBW)Birth weight less than 1500 gramsBirth weight less than 1500 grams

Extremely low birth weight (ELBW)Extremely low birth weight (ELBW)Birth weight less than 1000 gramsBirth weight less than 1000 grams

How Old Are You Anyway?How Old Are You Anyway?Gestational Age AssessmentGestational Age AssessmentGestational Age AssessmentGestational Age Assessment

A f b ’ dA f b ’ dAccurate assessment of a newborn’s age and Accurate assessment of a newborn’s age and size guides the caregiver in anticipation and size guides the caregiver in anticipation and

f h blf h blmanagement of the common problems management of the common problems related to age and growth statusrelated to age and growth status

Obstetric methods Obstetric methods

Assessment by physical examAssessment by physical examy p yy p y

LPTI EpidemiologLPTI Epidemiology

Most of the recent rise in preterm birth rate in the US is attributed to the LPTI

Very preterm birth (PTB) rate has been fairly stable since 1990

L PTB f 71% f bi hLate PTB accounts for over 71% of preterm births in the US

PTB is one of the leading causes of death in the 1stPTB is one of the leading causes of death in the 1st

month of life

Davidoff MJ et al Semin Perinatol 2006NCHS final natality data 2008

Increase in C/S Rate in Relation to Increase in C/S Rate in Relation to G i l AG i l AGestational AgeGestational Age

Total Cesarean DeliveriesTotal Cesarean DeliveriesTotal Cesarean DeliveriesTotal Cesarean DeliveriesUS and Kansas, 1996-2006

Source: National Center for Health Statistics, final natality data. Retrieved September 23, 2009, from www.marchofdimes.com/peristats.

L PTB C dLate PTB, Cesarean, andPregnancy Complicationsg y p

Yee & colleagues Obstet Gynecol 2008Yee & colleagues Obstet Gynecol 2008Canadian cohort

El i 36 38 4/7 kElective cesarean at 36-38 4/7 weeks

Associated with increased neonatal

Respiratory morbidity

Cesarean Section Delivery has Increased Cesarean Section Delivery has Increased T TT TRisks for LPTI, Term Infants and MomsRisks for LPTI, Term Infants and Moms

Elective C/S vs Vaginal birthElective C/S vs Vaginal birth/ g/ gIncrease in risk of NICU stay ≥ 7 daysIncrease in risk of NICU stay ≥ 7 days

OR 2.11 (conf interval 1.75OR 2.11 (conf interval 1.75--2.55)2.55)If h li i i i li b 1 7 f ldIf h li i i i li b 1 7 f ldIf cephalic presentation increase in mortality by 1.7 foldIf cephalic presentation increase in mortality by 1.7 foldIncreased risk of respiratory disease; Oxygen needIncreased risk of respiratory disease; Oxygen needReduces mortality associated with breech presentationReduces mortality associated with breech presentationy py pMaternal morbiditiesMaternal morbidities

DeathDeathHysterectomyHysterectomyHysterectomyHysterectomyBlood transfusionBlood transfusionIntensive care stayIntensive care stayAbAbAbx useAbx use Engle, Clinics in Perinatology, 2008

Villar, BMJ 2007Madar, Act Paediatr, 1999

Rise in Labor Induction Rate:Rise in Labor Induction Rate:Related to Increase in LPTI?

Left shift in delivery gestational ageRise in labor induction and cesarean rates – not

l i d b h i l d hiexplained by changing maternal demographics or risk factors

C/S on demand?Decrease in post dates

Davidoff & colleagues, Semin Perinatal 2006

Several studies show increasing rates of laborSeveral studies show increasing rates of labor induction in generalSeveral studies show increasing rates of medically i di t d LPTB b i d tiindicated LPTB by induction or cesarean

Late Preterm BirthsLate Preterm Births

Kansas, 1996-2006

US, 1996-2006

Late preterm is between 34 and 36 completed weeks gestationLate preterm is between 34 and 36 completed weeks gestation. Source: National Center for Health Statistics, final natality data. Retrieved September 14, 2009, from www.marchofdimes.com/peristats.

Late Preterm Births by Maternal AgeLate Preterm Births by Maternal AgeLate Preterm Births by Maternal AgeLate Preterm Births by Maternal Age

Kansas, 2004-2006 Average

US, 2004-2006 Average

Late preterm is between 34 and 36 completed weeks gestation. S N ti l C t f H lth St ti ti fi l t lit d tSource: National Center for Health Statistics, final natality data. Retrieved September 14, 2009, from www.marchofdimes.com/peristats.

Late Preterm Births by Race/EthnicityLate Preterm Births by Race/EthnicityLate Preterm Births by Race/EthnicityLate Preterm Births by Race/Ethnicity

Kansas, 2004-2006 Average

US, 2004-2006 Average

All race categories exclude Hispanics Categories do not sum to totalAll race categories exclude Hispanics. Categories do not sum to total since missing ethnicity data are not shown. Late preterm is between 34 and 36 completed weeks gestation. Source: National Center for Health Statistics, final natality data. Retrieved September 14, 2009, from www.marchofdimes.com/peristats.

Cost of PretermCost of PretermCost of PretermCost of PretermUS, 2005

Source: Institute of Medicine. 2006. Preterm Birth: Causes, Consequences, and Prevention. National Academy Press, Washington, D.C. Retrieved September 14, 2009, from www.marchofdimes.com/peristats.

Infant Deaths by Cause of DeathInfant Deaths by Cause of DeathInfant Deaths by Cause of DeathInfant Deaths by Cause of DeathUS, 2005

SIDS is Sudden Infant Death Syndrome. RDS is Respiratory Distress Syndrome. "Maternal Preg. Comp." stands for "Maternal Complications of Pregnancy." Cause of death for 1996-1998 is based on the Ninth Revision, International Classification of Diseases (ICD-9); cause of death for after 1998 is based on the Tenth Revision, International Classification of Diseases (ICD-10). Source: National Center for Health Statistics, period linked birth/infant death data. Retrieved September 14, 2009, from www.marchofdimes.com/peristats.

Risk factors for LPT BirthRisk factors for LPT Birth

Prior PTBPrior PTBRaceMaternal ageMaternal ageTobacco (21% mothers in US) or drugsI f iInfectionMaternal chronic disease or pregnancy

li ticomplicationsMultifetal pregnancies and ART

Iams JD Clin Perinatol 2003CDC

Morbidity for the LPTIMorbidity for the LPTIMorbidity for the LPTIMorbidity for the LPTI

R i diR i diRespiratory distressRespiratory distressHypothermiaHypothermiaHypoglycemiaHypoglycemiaFeeding problemsFeeding problemsHyperbilirubinemia/KernicterusHyperbilirubinemia/KernicterusRehospitalizationRehospitalizationppSIDSSIDSDevelopmental outcomesDevelopmental outcomesDevelopmental outcomesDevelopmental outcomes

Morbidity in the Late PTIMorbidity in the Late PTIMorbidity in the Late PTIMorbidity in the Late PTI

60 *

50

30

40

Full term*

*

20Near term

*

*

*P <.03

0

10

Temp Low BS IVF RDS Bili

Wang, Pediatrics, 2004

LPTI MorbiditiesLPTI Morbidities

Late PTB newborns 4-7 times more likely toLate PTB newborns 4 7 times more likely to have a least 1 medical condition

Temperature instability (10% vs 0%)p y ( )Hypoglycemia (16% vs 5%)RDS (29% vs 4%)( )Apnea (6% vs <0.1%)Jaundice (54% vs 38%)Feeding difficulties (32% vs 7%)ICN

ACOG Committee Opinion No. 404, 2008Engle W & Kominiarek MA. Clin Perinatol 2008Shapiro-Mendoza et al Pediatrics 2008

“E l T ” N“Early Term” Neonates

37-38 gestational weeks

Increased risk forRDS

TTNBTTNB

pulmonary hypertension

ICN admission or prolonged admissionICN admission or prolonged admission

Engle W & Kominiarek MA. Clin Perinatol 2008Escobar, Semin Perin, 2006

Supplemental OSupplemental O22

ff >>1 h1 h

Assisted Assisted ventilationventilation

Gestational ageGestational age

for for >>1 hour1 hour

OR [95% CI]OR [95% CI]

ventilationventilation

OR [95% CI]OR [95% CI]

3838--40 weeks40 weeks ReferenceReference ReferenceReference

37 weeks37 weeks 2 04 [1 612 04 [1 61--2 59]2 59] 2 35 [1 842 35 [1 84--3 02]3 02]37 weeks37 weeks 2.04 [1.612.04 [1.61--2.59]2.59] 2.35 [1.842.35 [1.84--3.02]3.02]

36 weeks36 weeks 4.95 [3.954.95 [3.95--6.21]6.21] 5.24 [4.115.24 [4.11--6.68]6.68]

35 weeks35 weeks 8.76 [6.778.76 [6.77--11.4]11.4] 9.04 [6.889.04 [6.88--11.9]11.9]

34 weeks34 weeks 18.7 [14.018.7 [14.0--24.9]24.9] 19.8 [14.719.8 [14.7--26.6]26.6]

33 weeks33 weeks 28.8 [20.428.8 [20.4--40.6]40.6] 31.9 [22.531.9 [22.5--45.3]45.3]

Escobar, Semin Perin, 2006

Temperature InstabilityTemperature InstabilityTemperature InstabilityTemperature Instability

Wang et al,Wang et al, PediatricsPediatrics,,Wang et al, Wang et al, PediatricsPediatrics, , 20042004

10% of LPTI 10% of LPTI experienced experienced temperature instability temperature instability compared to 0% of termcompared to 0% of termcompared to 0% of term compared to 0% of term infantsinfants

OR: infinite, OR: infinite, P P <.0012<.0012

Laptook, Semin Perin, 2006

HyperbilirubinemiaHyperbilirubinemiaHyperbilirubinemiaHyperbilirubinemiaSarici et al, Sarici et al, PediatricsPediatrics, , 2004200420042004

Prospective study that Prospective study that compared 146 nearcompared 146 near--term term i f t (35i f t (35 37 k ) t37 k ) tinfants (35infants (35--37 wks) to 37 wks) to 219 term 219 term The risk for significant The risk for significant hyperbili requiring hyperbili requiring phototherapy was phototherapy was 10.5%10.5%in term infants, in term infants, 25.3%25.3%in nearin near--term (2.4x more term (2.4x more likely)likely)Bilirubin levels peaked Bilirubin levels peaked ppin nearin near--term infants at term infants at 55--7 7 daysdays

HyperbilirubinemiaHyperbilirubinemiaHyperbilirubinemiaHyperbilirubinemia

Major Risk Factors for Severe Major Risk Factors for Severe jjHyperbilirubinemiaHyperbilirubinemia

Predischarge TSB in "highPredischarge TSB in "high--risk" zonerisk" zone

Jaundiced in first 24 hoursJaundiced in first 24 hours

Laboratory evidence of hemolytic diseaseLaboratory evidence of hemolytic disease

Gestational age 35 to 36 weeksGestational age 35 to 36 weeks

Significant bruisingSignificant bruising

Exclusive breastExclusive breast--feedingfeeding

Previous sibling received phototherapyPrevious sibling received phototherapy

East Asian raceEast Asian race

Other: IPM, male gender, maternal age >25Other: IPM, male gender, maternal age >25

HyperbilirubinemiaHyperbilirubinemiaHyperbilirubinemiaHyperbilirubinemiaMaisels et al, Maisels et al, PediatricsPediatrics, 1998, 1998

I i d f llI i d f ll i fi fIn a retrospective study of wellIn a retrospective study of well--infants;infants;Newborns at 35Newborns at 35--36 weeks were 36 weeks were 13.2x13.2x more likely to more likely to develop hyperbili requiring phototherapy, develop hyperbili requiring phototherapy, p yp q g p py,p yp q g p py,Newborns at 36Newborns at 36--37 weeks 37 weeks 7.7x7.7x more likely than more likely than infants born at infants born at >40 weeks40 weeks

N lN l A h P d Ad l M dA h P d Ad l M d 20002000Newman et al, Newman et al, Arch Ped Adol MedArch Ped Adol Med, 2000, 2000In a retrospective study of 51,387 newborn In a retrospective study of 51,387 newborn infants of >2000 g;infants of >2000 g;infants of >2000 g;infants of >2000 g;

Infants born at 36Infants born at 36--37 weeks' gestation were 37 weeks' gestation were 5.7x5.7x more more likely to develop significant hyperbilirubinemia than likely to develop significant hyperbilirubinemia than

''newborns at 39newborns at 39--40 weeks' gestation40 weeks' gestation

HypoglycemiaHypoglycemiaHypoglycemiaHypoglycemia

Late preterm infants are at higher risk for Late preterm infants are at higher risk for p gp ghypoglycemia due to decreased glycogen and hypoglycemia due to decreased glycogen and brown fat stores, decreased ketone response, brown fat stores, decreased ketone response, inadequate intake, and increased interventionsinadequate intake, and increased interventions

AmielAmiel--Tison et al, 2002Tison et al, 2002Found 9% of LPTI developed hypoglycemiaFound 9% of LPTI developed hypoglycemia

Wang et al, 2004Wang et al, 2004d 6% f T d dd 6% f T d dFound 15.6% of LTPI developed hypoglycemia Found 15.6% of LTPI developed hypoglycemia

compared to 5.3% of term OR 3.30 [1.1compared to 5.3% of term OR 3.30 [1.1--12.2]12.2]

Nearly 2/3 of LPTI required treatment with IVF forNearly 2/3 of LPTI required treatment with IVF forNearly 2/3 of LPTI required treatment with IVF for Nearly 2/3 of LPTI required treatment with IVF for correctioncorrection

Infection in the NearInfection in the Near--Term Term InfantInfant

Humoral immunity Humoral immunity –– involves antigen involves antigen antibody response that is most effective after antibody response that is most effective after dy pdy pprevious exposure. Immunoglobulins G, M, previous exposure. Immunoglobulins G, M, A and EA and E

Cellular immunity Cellular immunity –– specific and specific and nonspecific Specific involves T cellsnonspecific Specific involves T cellsnonspecific. Specific involves T cells, nonspecific. Specific involves T cells, nonspecific involves response of WBC and nonspecific involves response of WBC and complementcomplementcomplementcomplement

Rehospitalization of the LPTIRehospitalization of the LPTIRehospitalization of the LPTIRehospitalization of the LPTIEscobarEscobar % Rehosp% Rehosp % Rehosp% Rehosp OddieOddie

Gest AgeGest Age Gest AgeGest Age

>> 41 wks41 wks 3.6%3.6% 2.4%2.4% >40 wks>40 wks

3838--40 wks40 wks 4.4%4.4% 3.4%3.4% 3838--40 wks40 wks

37 wks37 wks 5 6%5 6% 37 wks37 wks37 wks37 wks 5.6%5.6% 37 wks37 wks

36 wks36 wks 7.3%7.3% 6.3%6.3% 36 wks36 wks

35 wks35 wks 6.8%6.8% 35 wks35 wks

34 wks34 wks 9.1%9.1%34 wks34 wks 9.1%9.1%Escobar, Semin Perin, 2006 Oddie, Arch Dis Child, 2005

NeurodevelopmentNeurodevelopmentNeurodevelopmentNeurodevelopment

Stein et alStein et al BWBW BW 1500BW 1500--Stein et al, Stein et al, PediatricsPediatrics, 2006, 2006

Evaluated 7817Evaluated 7817

ProblemProblem

BWBW

>2500g>2500g

BW 1500BW 15002499g2499g

L iL i 6 24%6 24% 12 46%12 46%Evaluated 7817 Evaluated 7817 children up to 12 children up to 12 years of age for years of age for

LearningLearning

problemproblem

6.24%6.24% 12.46%12.46%

y gy ghealth conditions health conditions or special care or special care

d did di

ADD/ADD/

ADHDADHD

5.37%5.37% 9.28%9.28%

need according to need according to birth weightbirth weight EmotionEmotion

behavbehav

12.27%12.27% 17.31%17.31%

behav behav probprob

L t PTB N t l O tLate PTB Neonatal Outcomes

Long-term outcomes: developmental delay, ADHD and behavior problems, respiratoryADHD and behavior problems, respiratory disorders

SIDSSIDSSIDSSIDS

The extent of breathing control maturation The extent of breathing control maturation ggis dependent on both gestational age and is dependent on both gestational age and chronological agechronological ageThe relative risk for ALTE events in late The relative risk for ALTE events in late preterm infants is higher than term infants preterm infants is higher than term infants (RR 5.6, (RR 5.6, PP <.008) and remains higher until <.008) and remains higher until 43 weeks' PMA43 weeks' PMAThe rate of SIDS in preterm infants born 33The rate of SIDS in preterm infants born 33--36 weeks is 1.37/1000 compared to 0.69/1000 36 weeks is 1.37/1000 compared to 0.69/1000 for inf nts 37for inf nts 37 42 eeks42 eeksfor infants 37for infants 37--42 weeks42 weeks

Implicated Factors forpIncreased Rate of LPTB

Increased surveillanceInaccurate gestational

Maternal autonomyPhysician practice

ageIncreased multifetal pregnancies

patternsConvenienceD li /pregnancies

Worsening maternal demographics

Delivery w/o indicationPlanned deliveryg p

Presumption of maturity at 34 wks

Planned deliveryDelivery mode

Fear of fetal risks

Prevention of Late LPTB

Accurate gestational datingprudent use of antenatal fetal testingprudent use of labor induction and

t ti i ifi t di lcesarean, targeting significant medical indications

Assisted reproductive technologyAssisted reproductive technology strategies to minimize multifetal gestationsg

LPTB at 34-36 Weeks: Should ItBe Arrested?

S h l b h ld b i d dSuggest that labor should not be induced at 34-35 weeks

Tocolysis and steroids “may be considered”Arnon S, et al, Paediatric & Perinatal Epidemiol 2001

bP = 0.008 compared with 36-week groupcP = 0.015 compared with the 36-week group

RecommendationsRecommendationsRecommendationsRecommendationsRecognize that late preterm infants are at risk for Recognize that late preterm infants are at risk for transitional problems:transitional problems:transitional problems:transitional problems:

Respiratory distressRespiratory distressHypoglycemiaHypoglycemiaH h iH h iHypothermia Hypothermia

Monitor for them appropriately, with scheduled Monitor for them appropriately, with scheduled routine surveillanceroutine surveillanceEstablish appropriate discharge criteria, discharge Establish appropriate discharge criteria, discharge screens, and discharge educationscreens, and discharge education

Bilir bin r ninBilir bin r ninBilirubin screeningBilirubin screeningCar seat screen (<37 weeks)Car seat screen (<37 weeks)Back To SleepBack To SleepLactation supportLactation support

RecommendationsRecommendations

Recognize risk factors for rehospitalizationRecognize risk factors for rehospitalization3434--36 weeks, exclusively breast36 weeks, exclusively breast--fed, male, cared for in fed, male, cared for in h l b i i h i hh l b i i h i hthe normal newborn nursery, primiparous mother with the normal newborn nursery, primiparous mother with

L&D complicationsL&D complications

Early (48 hrs), frequent and more prolongedEarly (48 hrs), frequent and more prolongedEarly (48 hrs), frequent and more prolonged Early (48 hrs), frequent and more prolonged followfollow--up (which may include home health visits or up (which may include home health visits or f/u phone calls) to assess breastf/u phone calls) to assess breast--feeding adequacy, feeding adequacy, p )p ) g q yg q yhydration status, and bilirubinhydration status, and bilirubin

Support and research in this everSupport and research in this ever--growing growing population to assess their needs and optimize carepopulation to assess their needs and optimize care

General GuidelinesGeneral GuidelinesGeneral GuidelinesGeneral Guidelinesfor Managing the LPTIfor Managing the LPTI

Remember the risksRemember the risks

Manage in least restrictive environment but Manage in least restrictive environment but with high degree of suspicion and promptwith high degree of suspicion and promptwith high degree of suspicion and prompt with high degree of suspicion and prompt intervention for problems. intervention for problems.

It’s better to back off from overtreatment than toIt’s better to back off from overtreatment than toIt s better to back off from overtreatment than to It s better to back off from overtreatment than to chase a baby who gets sick rapidly.chase a baby who gets sick rapidly.

Avoid early dischargeAvoid early dischargeAvoid early discharge Avoid early discharge

General Guidelines forGeneral Guidelines forGeneral Guidelines for General Guidelines for Management of the LPTIManagement of the LPTI

Educate the family about what to expect Educate the family about what to expect ––before, during, and after deliverybefore, during, and after delivery

The fewer surprises the betterThe fewer surprises the betterpp

Families who understand the issues are usually Families who understand the issues are usually more supportive and involved with caremore supportive and involved with care

Advocate and educate regarding the risks of Advocate and educate regarding the risks of the LPTIthe LPTI

Bottom Line for LPTIBottom Line for LPTIBottom Line for LPTIBottom Line for LPTI

Premature births are becoming increasingly more commonPremature births are becoming increasingly more commonPremature births are becoming increasingly more common Premature births are becoming increasingly more common in Americain America

Rising more than 30 percent in the last 25 yearsRising more than 30 percent in the last 25 years

Nearly 71 percent of those births being LPT babiesNearly 71 percent of those births being LPT babiesNearly 71 percent of those births being LPT babiesNearly 71 percent of those births being LPT babiesIncrease may be attributed to more early inductionsIncrease may be attributed to more early inductions

For medical or personal reasonsFor medical or personal reasons

Th di l f l i d iTh di l f l i d iThere are many medical reasons for early induction There are many medical reasons for early induction However, it’s becoming more common for women to request early However, it’s becoming more common for women to request early inductions for personal reasonsinductions for personal reasons

M h f l l b i id blM h f l l b i id blMuch of early labor is unavoidableMuch of early labor is unavoidableNeed to prepare parents who may be at risk or about to give birth to a late Need to prepare parents who may be at risk or about to give birth to a late preterm infant about the needs of these early babiespreterm infant about the needs of these early babies

With p t ti d l i t ti tWith p t ti d l i t ti tWith preventative care and early intervention, outcomes With preventative care and early intervention, outcomes can be improved can be improved

THE END

THANK YOU!THANK YOU!

ReferencesReferencesReferencesReferencesSeminars in PerinatologySeminars in Perinatology (2006) Feb; 30(1)(2006) Feb; 30(1)Seminars in PerinatologySeminars in Perinatology (2006) Apr; 30(2)(2006) Apr; 30(2)gygy ( ) p ( )( ) p ( )AAP guidelines (2004) Management of hyperbilirubinemia in the AAP guidelines (2004) Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. newborn infant 35 or more weeks of gestation. PediatricsPediatrics July; 114(1): July; 114(1): 297297--306.306.AAP guidelines (1996) Safe transportation of premature and low birthAAP guidelines (1996) Safe transportation of premature and low birthAAP guidelines (1996) Safe transportation of premature and low birth AAP guidelines (1996) Safe transportation of premature and low birth weight infants. weight infants. PediatricsPediatrics May; 97(5): 758May; 97(5): 758--60.60.Campbell, MA (2006) Development of a clinical pathway for nearCampbell, MA (2006) Development of a clinical pathway for near--term term and convalescing premature infants in a level II nursery. and convalescing premature infants in a level II nursery. Adv Neonatal Adv Neonatal CC J 6(3) 150J 6(3) 150 6464CareCare Jun; 6(3): 150Jun; 6(3): 150--64.64.Kirkegaard et al. (2006) Gestational age and birth weight in relation to Kirkegaard et al. (2006) Gestational age and birth weight in relation to school performance of 10school performance of 10--yearyear--old children: a followold children: a follow--up study of up study of children born after 32 completed weeks. children born after 32 completed weeks. PediatricsPediatrics October; 118(4): October; 118(4): 16001600--1606. 1606. Maisels MJ et al. (1998) Length of stay, jaundice, and hospital Maisels MJ et al. (1998) Length of stay, jaundice, and hospital readmission. readmission. PediatricsPediatrics 101: 995101: 995--98.98.MedoffMedoff--Cooper B et al (2005) The AWHONN NearCooper B et al (2005) The AWHONN Near--Term InfantTerm InfantMedoffMedoff--Cooper, B. et al. (2005) The AWHONN NearCooper, B. et al. (2005) The AWHONN Near--Term Infant Term Infant Initiative: a conceptual framework for optimizing health for nearInitiative: a conceptual framework for optimizing health for near--term term infants. infants. J Obstet Gynecol Neonatal NursJ Obstet Gynecol Neonatal Nurs NovNov--Dec; 34(6): 666Dec; 34(6): 666--7171..

ReferencesReferencesReferencesReferences

Newman TB et al. (2000) Prediction and prevention of extreme Newman TB et al. (2000) Prediction and prevention of extreme neonatal hyperbilirubinemia in a mature health maintenance neonatal hyperbilirubinemia in a mature health maintenance organization. organization. Arch Pediatr Adolesc MedArch Pediatr Adolesc Med 154: 1140154: 1140--47.47.Raju et al. (2006) Optimizing care and outcome for lateRaju et al. (2006) Optimizing care and outcome for late--preterm (nearpreterm (near--term) infants: a summary of the workshop sponsored by the NICHDterm) infants: a summary of the workshop sponsored by the NICHDterm) infants: a summary of the workshop sponsored by the NICHD. term) infants: a summary of the workshop sponsored by the NICHD. PediatricsPediatrics Sep; 118(3): 1207Sep; 118(3): 1207--14.14.Sarici et al. (2004) Hyperbilirubinemia in the nearSarici et al. (2004) Hyperbilirubinemia in the near--term newborn. term newborn. PediatricsPediatrics April; 113(4): 775April; 113(4): 775--780.780.p ; ( )p ; ( )Stein et al. (2006) Are children of moderately low birth weight at Stein et al. (2006) Are children of moderately low birth weight at increased risk for poor health? A new look at an old question. increased risk for poor health? A new look at an old question. PediatricsPediatricsJuly; 118(1): 217July; 118(1): 217--223.223.Wang, ML et al. (2004) Clinical outcomes of nearWang, ML et al. (2004) Clinical outcomes of near--term infants. term infants. PediatricsPediatrics Aug; 114(2): 372Aug; 114(2): 372--6.6.Wight, NE. (2003) Breastfeeding the borderline (nearWight, NE. (2003) Breastfeeding the borderline (near--term) preterm term) preterm i f ti f t P di t AP di t A M 32(5) 329M 32(5) 329 3636infant. infant. Pediatr AnnPediatr Ann May; 32(5): 329May; 32(5): 329--36.36.