Optimizing care and outcomes for late preterm neonates
- Rose R, Engle WA
- Curr Treat Options Peds
During the last years, I have witnessed the progress of neonatal intensive care. The application of CPAP, designed by Gregory back in 1971, as well as the adaptation and innovation of machinery and equipment for assisted ventilation specially focused on newborns, has produced a dramatic increase in survival among those who presented severe problems of respiratory failure, especially the large preterm infants. Due to these advances, neonatologists believed that they were able to overcome all problems and turned their attention to this population of extremely preterm infants. However, what about the ‘less premature’, the so-called ‘near term’ infants? Well, they were absolutely forgotten, despite they have gave us all the background during the process. This group of children represents 70% of all preterm infants and it is mainly responsible for the increase in prematurity. Those who was born between 34(+0) weeks and 36(+6) weeks of gestation, they are now called late preterm infants (LP) and they have finally been recognized as a population with a higher risk of neonatal morbidity and mortality compared to full term infants. This group does not only have respiratory problems, but also they have a higher risk of temperature instability, excessive weight loss and dehydration, sepsis, hypoglycemia and jaundice, requiring phototherapy. In addition to all these factors, the risk of neonatal mortality is 3 times higher than for the term infants. Some studies have also shown that late preterm infants have a potential risk of presenting more complications in their neurological development. It is clear, though, that their risk is lower than in large preterm infants, but it is higher than full term infants. If it is true that there are no protocols for caring late preterm infants in the neonatal period, it is even more true if we take into account that this population is subsequently controlled, in its vast majority, by the primary care pediatrician or, in certain levels, by the family doctor or nurse practitioner in Primary Health Care, without clinical guidelines that could give some kind of alert to their specific risks. Several studies published in leading pediatric magazines highlight that, compared to the healthy term infant’s group, the LP have almost double risk to present difficulties in their neurological development, with lower performance in the communication area, cognitive development, learning and behavior, and presenting even psychiatric disorders in adulthood.