Late preterm delivery

Late preterm delivery

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  LATE PRETERM DELIVERY34 0/7 – 36 6/7 WEEKS DECEMBER 2010
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  LATE PRETERM DELIVERYNEONATAL MORBIDITY During the initial birth hospitalization, late preterm infants are 4 times more likely than term infants to have at least 1 medical condition diagnosed and 3.5 times more likely to have 2 or more conditions diagnosed than term infants. During the initial birth hospitalization, late preterm infants compared to term infants are more likely to have the following Morbidities: Temperature instability Hypoglycemia Respiratory distress Apnea Hyperbilirubinemia Feeding difficulties AAP LATE PRETERM DELIVERY Pediatrics. 2007;120(6):1390-401 ACOG LATE PRETERM DELIVERY Number 404 • April 2008
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  LATE PRETERM DELIVERYMORBIDITY INCREASED WITH MATERNAL COMPLICATIONS This risk for neonatal morbidity rises even higher in infants delivered of mothers with additional Ob/Medical complications . Neonatal Morbidity rates are higher in late preterm infants whose mothers had maternal hypertension, diabetes, antepartum hemorrhage, and infections . The neonatal morbidity risk increased disproportionately higher than the expected neonatal morbidity for a given EGA. As an example ,a 12-fold increase in neonatal morbidity is associated with antepartum hemorrhage in late preterm infants which is greater than the expected EGA specific morbidity . Neonatal Morbidity rates increased with each additional maternal Ob or Medical complication 18 % with one maternal risk factor 29 % with two maternal risk factors 37 % with three maternal risk factors Pediatrics. 2008;121(2):e223-32.
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  LATE PRETERM DELIVERYREADMISSION AFTER DISCHARGE Readmission rates are two to three times greater for late preterm compared to term infants. Two Large Cohorts of late preterm deliveries demonstrated readmission rates over the first year of life were ~ 15% Specifically, Late preterm infants are three times more likely to be admitted within the first 15 days after discharge from the birth hospitalization ( 3.8 vs 1.3 %) . The most common reasons for early readmission are jaundice, feeding difficulties, poor weight gain, dehydration, and apnea . Respiratory and gastrointestinal disorders are the most common diagnoses for late readmission (≥15 days after the date of discharge) during the first year of life. Pediatrics. 2009;123(2):653-9 J Perinatol. 2007;27(10):614-9
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  LATE PRETERM DELIVERYINFANT MORTALITY The infant mortality rate (</= to 1 year) is higher among late-preterm infants than term infants. 7.7 / 1000 live births (0.8%) vs 2.5 / 1000 live births (0.25%) This threefold increase in mortality has remained relatively constant since 1995, at which time the infant mortality rate was 9.3 per 1000 live births among late-preterm infants and 3.1 per 1000 live births among term infants. AAP LATE PRETERM DELIVERY Pediatrics. 2007;120(6):1390-401
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  LATE PRETERM DELIVERYLONG TERM OUTCOME Increased risk for long-term neurodevelopmental morbidity Comparing late-preterm infants with term infants observational studies demonstrate a higher risk of Neurodevelopmental handicaps ie.. (mental retardation and developmental delay) Cerebral palsy (RR 3.39; 95% CI, 2.54-4.52) Behavioral abnormalities : scholastic, social, psychological development and behavioral difficulty (RR 1.5; 95% CI 1.2-1.8) Speech disorders AAP LATE PRETERM DELIVERY Pediatrics. 2007;120(6):1390-401 J Pediatr. 2009;154(2):169-76 N Engl J Med. 2008;359(3):262-73.