Late Preterm Infants

05/30/22 • 36 min

In this week’s gestational age episode, we talk about late preterm babies...you know, those “not-sure-how-I-am-gonna-act-just-yet” 34-36 weekers (and why they scare Michelle). We explore:

· Betamethasone for mom and how recommendations have changed

· Cold stress and bathing

· How to use your resources (like this podcast!)

· Why these babies are never a “sure thing” as far as their NICU stay is concerned.

Bibliography

Blackman, I. H. (2014). Factors influencing why nursing care is missed. Journal of Clinical Nursing, 24(1-2), 47-56. doi:10.1111/jocn.12688

Centers for Disease Control and Prevention. (2020). Infant Health. Retrieved from National Center for Health Statistics: https://www.cdc.gov/nchs/fastats/infant-health.htm

Chamberlain, J., McCarty, S., Sorce, J., Leesman, B., Schmidt, S., Meyrick, E., . . . Coultas, L. (2019). Impact on delayed newborn bathing on exclusive breastfeeding rates, glucose and temperature stability, and weight loss. Journal of Neonatal Nursing, 74-77.

Data USA. (n.d.). Hospitals: DataUSA. Retrieved from Data USA: Explore, Map, Compare, and DOwnload US Data: https://datausa.io/profile/naics/hospitals#about

Goodman, D., Little , G., & Harrison, W. (2019). The Dartmouth Atlas of Neonatal Intensive Care. Hanover: The Trustees of Dartmouth College.

Ogboenyiya, A., Tubbs-Cooley, H., Miller, E., Johnson, K., & Bakas, T. (2020). Missed nursing care in pediatric and noenatal care settings: an integrative review. American Journal of Maternal/Child Nursing, 254-264.

Warren, S., Midodzi, W., Newhook, L., Murphy, P., & Twells, L. (2020). Effects of delayed newborn bathing on breastfeeding, hypothermia, and hypoglycemia. JOGNN, 181-189. doi:10.1016/j.jogn.2019.12.004

Notes:

ACOG – American College of Obstetricians and Gynecologists. Want to see their betamethasone recommendation for this population for yourself? It’s here.

Chorioamnionitis (Chorio) – A bacterial infection of the chorion, amnion, and amniotic fluid. Often indicated by a high maternal fever, tender uterus, or foul-smelling amniotic fluid.

Cold Stress – Hypothermia (axillary temperature of less than 97.5° F) which causes an infant to have increased metabolic demands, often leading them to develop hypoxia, acidosis, and hypoglycemia.

Rationing Care – A term used to describe the situation where the nurse must decide which interventions to perform (and which to withhold) in order to accommodate their patient assignment. Read more about it in (Ogboenyiya, Tubbs-Cooley, Miller, Johnson, & Bakas, 2020)

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In this week’s gestational age episode, we talk about late preterm babies...you know, those “not-sure-how-I-am-gonna-act-just-yet” 34-36 weekers (and why they scare Michelle). We explore:

· Betamethasone for mom and how recommendations have changed

· Cold stress and bathing

· How to use your resources (like this podcast!)

· Why these babies are never a “sure thing” as far as their NICU stay is concerned.

Bibliography

Blackman, I. H. (2014). Factors influencing why nursing care is missed. Journal of Clinical Nursing, 24(1-2), 47-56. doi:10.1111/jocn.12688

Centers for Disease Control and Prevention. (2020). Infant Health. Retrieved from National Center for Health Statistics: https://www.cdc.gov/nchs/fastats/infant-health.htm

Data USA. (n.d.). Hospitals: DataUSA. Retrieved from Data USA: Explore, Map, Compare, and DOwnload US Data: https://datausa.io/profile/naics/hospitals#about

Goodman, D., Little , G., & Harrison, W. (2019). The Dartmouth Atlas of Neonatal Intensive Care. Hanover: The Trustees of Dartmouth College.

Notes:

ACOG – American College of Obstetricians and Gynecologists. Want to see their betamethasone recommendation for this population for yourself? It’s here.

Chorioamnionitis (Chorio) – A bacterial infection of the chorion, amnion, and amniotic fluid. Often indicated by a high maternal fever, tender uterus, or foul-smelling amniotic fluid.

Cold Stress – Hypothermia (axillary temperature of less than 97.5° F) which causes an infant to have increased metabolic demands, often leading them to develop hypoxia, acidosis, and hypoglycemia.

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Previous Episode

Early term/ Term infants

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The second episode in our gestational age series, today we talk about early-term (near-term)/term infants in the NICU. These are babies born between 37 0/7-weeks and 40 6/7-weeks. We talk about:

What on Earth brings these babies to the NICU?!
Assessment findings and expectations for uncomplicated newborns
What findings should make you really suspicious
How recent practice changes have impacted the care these babies receive (baby-friendly, antibiotic stewardship, etc.)
What normal newborn care looks like, including discharge testing

We also break down APGAR scoring...though the one thing we didn’t specifically say is that APGAR scores are determined at one minute of life, 5 minutes of life. Additional APGAR scores are given every 5 minutes for 20 minutes or until a score of 7 or better is achieved.
As promised, a better look at the Baby-Friendly Hospital Initiative.

Bibliography

Health Resources and Services Administration. (2022, March). Critical congenital heart disease. Retrieved from Health Resources and Services Administration: newborn screening: https://newbornscreening.hrsa.gov/conditions/critical-congenital-heart-disease

Korang, S. K., Safi, S., Gluud, C., Lausten-Thomsen, U., & Jakobsen, J. C. (2019). Antibiotic regimens for neonatal sepsis - a protocol for a systematic review with meta-analysis. Systematic Reviews, 8, Article number: 306. doi:10.1186/s13643-019-1207-1

Martin, M. G., Ewer, M. A., Gaviglio, M. L., Horn, R. E., Saarinen, M. A., Sontag, P. M., . . . Oster, M. M. (2020). Updated strategies for pulse oximetry screening for critical congenital heart disease. Pediatrics, e20191650. doi:10.1542/peds.2019-1650

National Organization for Rare Diseases, Inc. (2007). Aplasia cutis congenita. Retrieved from NORD Rare Diseases Database: https://rarediseases.org/rare-diseases/aplasia-cutis-congenita/

Neonatal early‐onset sepsis calculator recommended significantly less empiric antibiotic treatment than national guidelines. (2020, Dec). Acta Paediatrica, 2549-2551.

Ramasethu, J., & Kawakita, T. (2017, October). Antibiotic stewardship in perinatal and neonatal care. Seminars in Fetal and Neonatal Medicine, 278-283. doi:10.1016/j.siny.2017.07.001

For definitions of terms used, visit Early-Term/Term Babies — Neonatal Resources, the Podcast (nicu-resources.com) and view our notes.

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Next Episode

Moderate Preterm

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Perhaps the cutest of the ages, the “almost grown enough to skip the NICU” moderate preterm babies are the topic this week. These babies are 32 and 0/7-weeks to 33 and 6/7-weeks but the discussion extends to the late pretermers who find themselves in a NICU. There has been so much research in the last few years about these babies and the things that impact them both short and long term! Join us as we discuss:

Cue based feeding in the moderate/late preterm
Betamethasone and Magnesium sulfate in this group and how it impacts infants at delivery
What it means to support an infant’s natural ability vs impose medical standards
Early neonatal research (the name wouldn’t come during our recording but, if you want to know, it was Dr. Edgar Rey Sanabria in 1978)

As if all of that wasn’t fun enough...we also talk about jaundice, the plague...and zombies?!?! Honestly, we haven’t laughed that hard in a long time! We hope you will laugh along with us. If our suspicions are correct, this won’t be the last time this comes up!

Bibliography:

Bulut, A., Cundubey, C., Ceyhan, V., & Aydin, E. (2022). Comparison of neonatal outcomes with and without the administration of betamethasone in late preterm births. International Journal of Gynecology and Obstetrics, 349-354. doi:10.1002/ijgo.14028

Chollat, C., Sentilhes, L., & Marret, S. (2018). Fetal neuroprotection by magnesium sulfate: from translational research to clinical application. Frontiers in Neurology, 247.

Conde-Agudelo, A., & Diaz-Rossello, J. (2016). Kangaroo mother care to reduce morbidity and mortality in low birth weight infants. Cochrane Database of Systematic Reviews(8), Art. No.: CD002771. doi:10.1002/14651858.CD002771.pub4

Kamran, F., Khatoonabadi, A. R., Aghajanzadeh, M., Ebadi, A., Faryadras, Y., & Sagheb, S. (2020). Effectiveness of cue-based feeding versus scheduled feeding in preterm infants using comprehensive feeding assessment scales: a randomized clinical trial. Iran Journal of Pediatrics, :e107475. doi:10.5812/ijp.107475.

Woythaler MS, DO, M. (2019). Neurodevelopmental outcomes of the late preterm infant. Seminars in Fetal and Neonatal Medicine, 54-59. doi:10.1016/j.siny.2018.10.002

Notes:

EDC – Estimated date of confinement, also call the estimated date of delivery (EDD) or the due date. This uses the date of the last menstrual period to estimate the date of a 40-week, full term delivery. The calculation is based on Naegele's rule. If you want a cheat try this calculator.

Gestational Age – The number of completed weeks of a pregnancy at the time of delivery. Clinically, the gestational age assessment is based on the EDC, fetal ultrasound measurements, and gestational age scoring done at delivery. Check out this Get Your Pens for an in-depth look

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