Optimizing Care and Outcome for Late-Preterm (Near-Term) Infants: A Summary of the Workshop Sponsored by the National Institute of Child Health and Human Development

Department of Pediatrics, Baylor College of Medicine, Houston, Texas, United States
PEDIATRICS (Impact Factor: 5.47). 09/2006; 118(3):1207-14. DOI: 10.1542/peds.2006-0018
Source: PubMed


In 2003, 12.3% of births in the United States were preterm (< 37 completed weeks of gestation). This represents a 31% increase in the preterm birth rate since 1981. The largest contribution to this increase was from births between 34 and 36 completed weeks of gestation (often called the "near term" but referred to as "late preterm" in this article). Compared with term infants, late-preterm infants have higher frequencies of respiratory distress, temperature instability, hypoglycemia, kernicterus, apnea, seizures, and feeding problems, as well as higher rates of rehospitalization. However, the magnitude of these morbidities at the national level and their public health impact have not been well studied. To address these issues, the National Institute of Child Health and Human Development of the National Institutes of Health invited a multidisciplinary team of experts to a workshop in July 2005 entitled "Optimizing Care and Outcome of the Near-Term Pregnancy and the Near-Term Newborn Infant." The participants discussed the definition and terminology, epidemiology, etiology, biology of maturation, clinical care, surveillance, and public health aspects of late-preterm infants. Knowledge gaps were identified, and research priorities were listed. This article provides a summary of the meeting.

37 Reads
  • Source
    • "childhood , has been established in previous liter - ature ( Bird et al . , 2010 ; Engle et al . , 2007 ; Martin et al . , 2009 ; Medoff - Cooper et al . , 2012 ; Raju et al . , 2006 ) . However , a gap remains in the evidence to support models of postdischarge care that may improve outcomes for this population ( Premji et al . , 2012 ) . The majority of LPIs are not enrolled in high - risk infant follow - up programs that generally focus on very preterm infants ( Walker et al . , 2012 ) . Additionally , recent evid"
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective To describe use of the emergency department (ED) among late preterm versus term infants enrolled in a home visiting program and to determine whether home visiting frequency was associated with outcome differences.DesignRetrospective, cohort study.SettingRegional home visiting program in southwest Ohio from 2007–2010.ParticipantsLate preterm and term infants born to mothers enrolled in home visiting. Program eligibility requires ≥ one of four characteristics: unmarried, low income, < 18 years, or suboptimal prenatal care.Methods Data were derived from vital statistics, hospital discharges, and home visiting records. Negative binomial regression was used to determine association of ED visits in the first year with late preterm birth and home visit frequency, adjusting for maternal and infant characteristics.ResultsOf 1,804 infants, 9.2% were born during the late preterm period. Thirty-eight percent of all infants had at least one ED visit, 15.6% had three or more. No significant difference was found between the number of ED visits for late preterm and term infants (39.4% vs. 37.8% with at least one ED visit, p = .69). In multivariable analysis, late preterm birth combined with a maternal mental health diagnosis was associated with an ED incident rate ratio (IRR) of 1.26, p = .03; high frequency of home visits was not significant (IRR = .92, p = .42).Conclusions Frequency of home visiting service over the first year of life is not significantly associated with reduced ED visits for infants with at-risk attributes and born during the late preterm period. Research on how home visiting can address ED use, particularly for those with prematurity and maternal mental health conditions, may strengthen program impact and cost benefits.
    Journal of Obstetric Gynecologic & Neonatal Nursing 03/2015; 44(1). DOI:10.1111/1552-6909.12538 · 1.02 Impact Factor
  • Source
    • "Infants born between 34 0/7 and 36 6/7 weeks of gestational age (GA) should preferably be referred to as 'late preterm,' rather than as 'near term,' to better convey their vulnerability and need for closer monitoring and follow up (Raju et al., 2006). Late preterm infants (LPIs) are at an increased risk for bradycardia, feeding difficulties, hypoglycaemia, jaundice, respiratory distress, sepsis, temperature instability, and hospital readmission (Engle et al., 2007; Celik et al., 2013). "
    [Show abstract] [Hide abstract]
    ABSTRACT: to compare the influence of supplementary artificial milk feeds on breast feeding and certain clinical parameters among healthy late preterm infants given regular supplementary artificial milk feeds versus being exclusively breast fed from birth. a comparative study using quantitative methods. Data were collected via a parental diary and medical records. parents of 77 late preterm infants (34 5/7-36 6/7 weeks), whose mothers intended to breast feed, completed a diary during the infants׳ hospital stay. infants who received regular supplementary artificial milk feeds experienced a longer delay before initiation of breast feeding, were breast fed less frequently and had longer hospital stays than infants exclusively breast fed from birth. Exclusively breast-fed infants had a greater weight loss than infants with regular artificial milk supplementation. A majority of the mothers (65%) with an infant prescribed artificial milk never expressed their milk and among the mothers who used a breast-pump, milk expression commenced late (10-84 hours after birth). At discharge, all infants were breast fed to some extent, 43% were exclusively breast fed. clinical practice and routines influence the initiation of breast feeding among late preterm infants and may act as barriers to the mothers׳ establishment of exclusive breast feeding. Copyright © 2015. Published by Elsevier Ltd.
    Midwifery 12/2014; 31(4). DOI:10.1016/j.midw.2014.12.004 · 1.57 Impact Factor
  • Source
    • "In contrast with birth data [1] from the United States, a lower rate of LPI (5.9% vs 9.1%) and a lower incidence of LPI among preterm infants (57% vs 75%) were observed. Although this study was carried out in a single third level centre, results are in keeping with the overall rate of preterm delivery of 6.8% in Italy [14], similar to the rate of many European countries [15] and about half that in the U.S. [16]. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective To evaluate short-term respiratory outcomes in late preterm infants (LPI) compared with those of term infants (TI). Methods A retrospective study conducted in a single third level Italian centre (2005–2009) to analyse the incidence and risk factors of composite respiratory morbidity (CRM), the need for adjunctive therapies (surfactant therapy, inhaled nitric oxide, pleural drainage), the highest level of respiratory support (mechanical ventilation – MV, nasal continuous positive airway pressure – N-CPAP, nasal oxygen) and the duration of pressure support (hours in N-CPAP and/or MV). Results During the study period 14,515 infants were delivered. There were 856 (5.9%) LPI and 12,948 (89.2%) TI. CRM affected 105 LPI (12.4%), and 121 TI (0.9%), with an overall rate of 1.6%. Eighty-four LPI (9.8%) and 73 TI (0.56%) received respiratory support, of which 13 LPI (1.5%) and 16 TI (0.12%) were ventilated. The adjusted OR for developing CRM significantly increased from 3.3 (95% CI 2.0-5.5) at 37 weeks to 40.8 (95% CI 19.7-84.9%) at 34 weeks. The adjusted OR for the need of MV significantly increased from 3.4 (95% CI 1.2-10) at 37 weeks to 34.4 (95% CI 6.7-180.6%) at 34 weeks. Median duration of pressure support was significantly higher at 37 weeks (66.6 h vs 40.5 h). Twin pregnancies were related to a higher risk of CRM (OR 4.3, 95% CI 2.6-7.3), but not independent of gestational age (GA). Cesarean section (CS) was associated with higher risk of CRM independently of GA, but the OR was lower in CS with labour (2.2, 95% CI 1.4-3.4 vs 3.0, 95% CI 2.1-4.2). Conclusions In this single third level care study late preterm births, pulmonary diseases and supportive respiratory interventions were lower than previously documented. LPI are at a higher risk of developing pulmonary disease than TI. Infants born from elective cesarean sections, late preterm twins in particular and 37 weekers too might benefit from preventive intervention.
    Italian Journal of Pediatrics 06/2014; 40(1):52. DOI:10.1186/1824-7288-40-52 · 1.52 Impact Factor
Show more

Similar Publications