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: 5.3). 09/2006; 118(3):1207-14. DOI: 10.1542/peds.2006-0018
Source: PubMed

ABSTRACT 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.

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    • "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"
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    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 01/2015; 44(1). DOI:10.1111/1552-6909.12538 · 1.20 Impact Factor
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    • "From the total infants that survive after being delivered prematurely, about 10–15% are significantly disabled. Preterm infants are born with multiple short-and long-term health complications including bronchopulmonary dysplasia, necrotizing enterocolitis , retinopathy of prematurity, cognitive impairment, and an increased risk for adult onset diseases such as hypertension and diabetes [8] [9] [10]. Another less well known complication is that when infants are born preterm, there is an interruption of normal renal organogenesis involving the vascular tree and kidney branching increasing the susceptibility of the surviving infants to develop hypertension and renal disease as adults [11]. "
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    ABSTRACT: We aim to identify the link between placental histological findings and obstetric reports to determine possible risk factors of spontaneous preterm birth (SPTB). We prospectively ascertained birth records and outcomes from all deliveries in our hospital in 1 year. Records were used to determine and stratify for either full-term or preterm [spontaneous or indicated (I)] deliveries. We analyzed for risk factor association using χ(2) tests and common odds ratio estimates (SPSS v21.0). Our cohort totaled 6088 deliveries: 236 IPTB, 43 SPTB, and 5809 term births. Largely Hispanic, we determined race, parity, prenatal care access, preeclampsia, gestational diabetes, and BMI to be highly associated with SPTB (p < 0.01). Histologically, placentas of women with SPTB were twice as likely to have chronic villitis. We found that chronic villitis is associated with SPTB. Results of this study can be used in increasing the understanding of SPTB.
    Fetal and pediatric pathology 05/2014; 33(4). DOI:10.3109/15513815.2014.913749 · 0.40 Impact Factor
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    • "In a recent study that assessed sensory modulation and participation on the same group of infants, we have found an increased risk for sensory modulation dysfunction and decreased participation in LPI compared to TI at the age of 12 month (Bart, Shayevits, Gabis, & Morag, 2011). Most of these studies are retrospective, include healthy singleton LPI and lack perinatal data, hence the need for a prospective developmental follow up of LPI during early infancy has been noted (Raju et al., 2006; van Baar et al., 2009). "
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    ABSTRACT: AIM: To longitudinally assess the neurodevelopmental outcomes of late preterm infants (LPI) through the first year of life and to investigate for perinatal conditions that may affect developmental outcomes. METHODS: The study population comprised of 124 LPI, born in a single Israeli inborn center over an eight months period. Thirty-three term infants (TI) were recruited for comparison. Alberta Infant Motor Scale (AIMS) for gross motor evaluation was performed at 6 months of age and the Griffiths Mental Development Scales (GMDS) were performed at 12 months (chronological age). Maternal and neonatal covariates, potentially associated with low developmental scores, were analyzed by multivariate logistic regression models. RESULTS: At chronological age of 6 and 12 months, LPI performed significantly lower than TI on all subscales, but when scores were corrected for post conception age, developmental scores were similar in the two groups. In a multivariate model of logistic regression, male gender, emergent cesarean section and higher maternal education (>14 years) were found to be associated with increased risk for lower developmental scores at 12 month of age in LPI. CONCLUSIONS: LPI do not complete their neurodevelopmental maturation by the first year of life. Males and those born after emergent cesarean section (CS) are at increased risk for lower developmental scores. Correction of age to term birth in LPI may still be needed at this age.
    Infant behavior & development 04/2013; 36(3):451-456. DOI:10.1016/j.infbeh.2013.03.010 · 1.34 Impact Factor
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