Late Preterm Infants

An infant is considered late born prematurely when he comes between the 34th and 37th week of gestation.

The normal pregnancy lasts 40 weeks of gestation (fluctuates 37-42 weeks). Late preterm babies often seem to have the same size as born to rule, term infants, but because of their prematurity increased morbidity. Late preterm births represent almost three quarters of all premature births, the rate of late preterm births has increased in the last two decades, from 7.2% in 1990 to 8.3% in 2011. Many late preterm births are medically indicated.

An infant is considered late born prematurely when he comes between the 34th and 37th week of gestation. The normal pregnancy lasts 40 weeks of gestation (fluctuates 37-42 weeks). Late preterm babies often seem to have the same size as born to rule, term infants, but because of their prematurity increased morbidity. Late preterm births represent almost three quarters of all premature births, the rate of late preterm births has increased in the last two decades, from 7.2% in 1990 to 8.3% in 2011. Many late preterm births are medically indicated. Etiology Late preterm births are sometimes medically indicated (eg. As a result of pre-eclampsia, placenta previa / placenta accreta or premature membrane rupture) and are often carried out with caesarean section. For a given patient, the cause of spontaneous late preterm and -entbindung is not usually known. However, the risk factors are similar to those generally consist of premature birth (premature infant child: etiology), and chronic chorioamnionitis may be associated with spontaneous late preterm births. Complications Although doctors tend to focus on the more serious and more obvious complications of preterm infants born <34 weeks of pregnancy, have late preterm risk for many of the same problems. They have longer hospital stays and higher incidences of reuptake and undiagnosed medical disorders than full-term infants. Most complications are related to the immaturity of many organ systems and are similar to those of infants who were born early (premature infant child: complications), but are less difficult in general. However, some complications of preterm infants (z. B. necrotising enterocolitis, retinopathy of prematurity, bronchopulmonary dysplasia, intracranial bleeding) in late preterm infants are rare. In most cases, the complications completely regress. Complications include the following: CNS: episodes of apnea (apnea of ??prematurity) gastrointestinal tract: poor feeding due to delayed maturation of sucking and swallowing mechanisms (main reason for the prolonged hospitalization and / or reuptake) hyperbilirubinemia: caused by immature mechanisms for liver Bilirubinstoffwechsel and / or increased intestinal absorption of bilirubin (. for example, when feeding difficulties cause decreased bowel motility, neonatal hyperbilirubinemia) hypoglycemia: caused by low glycogen (neonatal hypoglycemia) lungs: respiratory distress syndrome (caused by insufficient surfactant production idiopathic respiratory distress syndrome in neonates); transient tachypnea of ??the newborn (Transient tachypnea of ??the newborn) Temperature Instability: a degree of supercooling in half of the infants (caused by the increased surface to volume ratio, reduced fat and ineffective thermogenesis of de Brown fat, hypothermia in newborns) diagnosis by new Ballard -Score estimated gestational routine screening for metabolic complications findings on physical examination are correlated with gestational age (assessment of gestational age-new Ballard score). Glucose measurements are for a minimum of 24 hours required, especially when there is no regular feedings have been established. To routine evaluations include pulse oximetry, calcium and electrolytes in serum, whole blood count and bilirubin. The infants should be monitored for apnea and bradycardia, until they are old 34.5 to 35 weeks (adjusted to age) or both no longer occur. Glucose measurements are for a minimum of 24 hours required, especially when there is no regular feedings have been established. The bilirubin levels are clinically observed in the first week of life. Prognosis The prognosis depends on the complications and its severity, but typically decrease mortality and complications with increasing gestational age and birth weight. Most CNS problems usually resolve spontaneously. The breath control is mature usually between the 37th to 38th week of pregnancy and the apnea events put in to the 43rd week. However, some children mild developmental delays and school problems, so that all follow-up investigation of neurological development and, as required should have an adequate and early referral to intervention programs. Lung problems subside normally, but some infants develop pulmonary hypertension. Therapy Supportive treatment Identified diseases are treated. For infants with no specific findings, the support to body temperature and feeding concentrated. Premature babies, because of the metabolic demands to maintain the core body temperature under stress suffer (hypothermia in newborns). Therefore it should stay in a neutral thermal environment, which represents the ambient temperature in which the metabolic requirements (so that the calorie consumption and) to maintain the body temperature in the normal range are the lowest. The neutral thermal environment has a small span of 36.7 ° C to 37.3 ° C. Breastfeeding is highly recommended. Most late preterm infants tolerate breast milk and thus be supplied with immunological factors and other important nutrients in cow's milk (or infant formula from cow's milk) is not included. When the infants not adequately suck and / or swallow, the feedings should be made by NGT, starting with small amounts and the amount is increased over time. Important Points While late preterm infants (? 34 and <37 weeks) may resemble full-term infants in their size and appearance, they have an increased Kommplikationsrisiko. Complications include hypothermia, hypoglycemia, respiratory distress syndrome, hyperbilirubinemia and problems with feeding. The findings are discussed and body temperature and feeding are supported. Follow-up investigation of the neurological development are carried out to identify any disabilities and to respond accordingly.

Health Life Media Team

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