Hugo A. Navarro, M.D.
Medical Director
SCN Alamance Regional Medical Center
Assistant Professor DUMC
Goals
 Increase awareness of vulnerability in late preterm and
early term infants
 Definition and incidence
 Discuss physiologic limitations
 Morbidity and Mortality
 Questions
Incidence of early term birth
 Births of infants > 40 weeks gestation has declined,
whereas the early term infants has increased
 Approximately 700,000 births/year in USA (17.5% of live
births) occur 37 0/7-38 6/7 weeks of gestation
Why?
 Is multifactorial:
 Increased surveillance and medical interventions
 Inaccurate gestational age estimates
 Presumption of fetal maturity at 34 weeks’ gestation
 Changes in maternal demographics and health
Why?
 Increased rates of elective cesarean sections and
inductions of labor
 Maternal and physician concerns about complications of
vaginal delivery and subtle changes in medical thresholds
for cesarean birth
 Willingness of mothers to incur risk on behalf of their child
Preterm ≠ LPT ≠ ET ≠ Term
 ↑risk for medical
complications
that result in higher morbidity
and mortality during birth
hospitalization
The ↑ in LPT and ET, raises
the risk for physiologically
immature infants
 ↑admissions to NICU and
duration of hospital stay,
disrupting the infant-family
bonding
 ↑ rates of readmission during
the neonatal period
 ↑long-term complications
Most common problems/treatments in
descending order
Feeding problems
Respiratory distress
Evaluation for sepsis
Intravenous fluids
Jaundice
Hypoglycemia
Temperature instability
Apnea
Mechanical ventilation
POOR FEEDER
Lower the GA
worst the feeding skills
Dehydration
Hyperthermia
Hypoglycemia
Hyperbilirubinemia
IV fluids
Antibiotics
Phototherapy
ADMISSION
Summary
 LPT and ET infants are at greater risk than term infants
for acute and long-term complications of premature birth
 The rates of LPT and ET births are increasing
 Causes for the increase in rates of LPT and ET infants are
unclear
 The route and timing of delivery of LPT and ET NB infants
have important implications for short-term and long-term
neonatal outcomes
Summary
 The risks and benefits for planned induction of labor, or
elective cesarean section for mother and infant should be
carefully considered by mothers, families, and physicians
when determining the optimal timing and route of
delivery
 Our understanding of the maternal, fetal, neonatal, and
long-term outcomes and causes of LPT and ET births is
incomplete
Summary
 Research is needed to increase our understanding of
maternal and infant outcomes of infants born at 34 to 38
weeks’ gestation, to determine the efficacy and safety of
strategies to optimize these outcomes, and to develop
interventions that effect physiologic maturation of the
fetus when premature delivery is necessary or elective