Late Preterm Research Articles

Early discharge of premature infants < 37weeks gestational age with nasogastric tube feeding: the new standard of care?

Most premature infants are hospitalised until they no longer need monitoring of vital parameters and are independent of nasogastric tube feeding (NTF). Hospital admission time easily reaches a length of multiple months in extremely preterm infants, but also in late preterms, in whom drinking may be the only problem, hospital admission time can reach weeks. This is a very stressful time for both parents and child. Parents in the Albert Schweitzer Hospital (ASH) are taught to give their child NTF. When monitoring is no longer necessary, the child can be discharged with NTF, with home care by paediatric nurses. In this study duration of NTF at home, safety of the procedure and parental satisfaction with NTF at home were evaluated. Duration of NTF at home was compared to admission time from cessation of monitoring till discharge independent of NTF in infants born in two comparable hospitals where discharge with NTF is not standard care. Median duration of NTF at home in the ASH infants was 9days. In the control group, median admission time after cessation of monitoring was 9days. No complications related to NTF at home were noted. Ninety-six percent of parents regarded NTF at home as safe and would repeat it in the future.Conclusion: NTF at home in premature infants shortens hospital admission time, is safe and results in high parental satisfaction rates. What is Known: • Premature infants are most often hospitalised until they are no longer dependent on NTF. Hospital admission time therefore easily reaches a length of multiple months for the extremely preterm infant. This can be a very stressful time for both parents and child. What is New • Making discharge with NTF in otherwise stable premature infants possible, by teaching parents the procedure and by providing home care by paediatric nurses. • NTF at home in premature infants is safe, limits hospital admission time and has high parental satisfaction rates.

Health of Preterm Newborns at the Health Promoting Hospital: The Effect of Postpartum Education on Child Care.

Objective: The recent studies have revealed that postpartum parental education, and surveillance has a great importance for the optimum home care of late premature infants during their transition period. The aim of this research was ensure the optimum health care and sustainability of home care of late preterms during transition by delivering necessary health education to mothers; hence, to prevent potential problems which may rise in relation with inappropriate home care; to minimize the rehospitalization rate of infants during the first three months of their lives which might otherwise seen more frequently by monitoring general health state of the infants. Method: This prospective, descriptive research carried out as case-control survey was performed using a cross-sectional method and questionnaire forms so as to collect data. Seventy 70 singleton late preterm infants who were born at 34 to 36 gestational weeks at a Training and Research Hospital in Istanbul were included in the survey after obtaining ethics committee approval. The mothers of the newborns included in the experimental study group were given health education about home care of the baby by a newborn nurse (researcher) experienced in child care during two visits. The education included basic newborn care and the symptoms of the diseases. Both groups were followed up at the postpartum first and third months. Results: Indications for hospitalisation soon after birth were respiratory distress in 66.7%, and hyperbilirubinemia in 33.3 % of the cases in the experimental group. In the control group patients were hospitalized with the indications of respiiratory distress (77.8%), prematurity (5.6%), hyperbilirubinemia (11.1%), and infection (5.6%). In the experimental group diaper dermatitis at the first, and burring/yellow eye discharge at third months were significantly less frequent in the experimental group at and third months (p

Impact of the new guidelines on the management of premature rupture of membranes for the prevention of late preterm birth: an 11-year retrospective study.

Objectives To evaluate the number of late preterm (LPT) births (between 34 0/7 and 36 6/7 weeks) that could have been prevented if expectant management of preterm premature rupture of membranes (PPROM) had been applied according to new recommendations. Methods A retrospective cohort study included all births at one Swiss center between January 1, 2002 and December 31, 2012. Births were categorized using an adapted evidence-based classification. Two scenarios were considered: best scenario (maximum averted cases) and a conservative scenario (minimum averted cases). Results Among 2017 LPT births (5.0% of all deliveries; n=40,609), 1122 (60.6%) women had PPROM. Spontaneous labor occurred in 473 (42.2%) cases and 649 (57.8%) had induction of labor or an elective cesarean section. In the latter group, 44 (6.8%) had evidence-based indications for LPT delivery and 605 (83.2%) had non-evidence-based indications. Depending on the scenario, the rate of avoided LPT cases would have varied between 4.2% (95% confidence interval [CI]: 3.4-5.2) if the conservative scenario was applied, and 30% (95% CI: 28.0-32.0) for the best scenario. Conclusion Adoption of new guidelines for the management of PPROM will prevent a considerable number of LPT births and help decrease the adverse effects and potential disability associated with late preterm infants.

Nutritional management of moderate-late preterm infants: Survey of current practice.

Moderate-late preterm (MLPT) babies account for over 80% of preterm babies born world-wide. Many MLPT babies require early nutritional support while full sucking feeds are established, but there is little evidence to guide practice. We aimed to determine current practice in Australia and New Zealand. An electronic survey was sent to neonatal clinical directors within the Australia and New Zealand Neonatal Network requesting dissemination to colleagues involved in the care of MLPT babies (32-35+6 weeks' gestation). The questionnaire asked about respondents' nutritional management of MLPT babies and included scenarios for both moderate- (MPT) and late preterm (LPT) babies. There were 83 respondents. While waiting for mothers' milk to meet prescribed fluid volumes, 61% (MPT) to 53% (LPT) of respondents would provide dextrose 10% as the first nutritional support, with 15% (MPT) to 38% (LPT) providing infant formula. Of clinicians providing 10% dextrose, 31% (MPT) to 49% (LPT) were happy to do so for ≥3 days, with 5% comfortable doing so for 5 days in moderately preterm babies, before providing additional support. This additional support was infant formula in 73% (MPT) to 90% (LPT) of respondents. There is variation in the nutritional management of MLPT infants amongst neonatal clinicians, likely due to the lack of evidence from randomised controlled trials on which to base clinical practice. The majority of clinicians are happy providing only dextrose 10% for up to 2-3 days despite this form of nutritional support containing only carbohydrate.

Visual and Hearing Impairments After Preterm Birth.

Our aim was to determine and compare the incidences of sensory impairments among very preterm (VP) (<32 + 0/7 weeks), moderately preterm (MP) (32 + 0/7-33 + 6/7 weeks), late preterm (LP) (34 + 0/7-36 + 6/7 weeks), and term infants (≥37 weeks) and to establish risk factors of neurosensory disabilities. This national register study included all live-born infants in Finland between 1991 and 2008. Infants who died before the age of 1 year, who had any major congenital anomaly, or had missing data were excluded (n = 21 007; 2.0%). A total of 1 018 256 infants were analyzed. Incidences of hearing loss, visual disturbances or blindness, other ophthalmologic disorders, and retinopathy of prematurity were determined for gestational age (GA) groups. Risk factors of hearing loss and visual disturbances or blindness were analyzed. The incidences of sensory impairments decreased with advancing GA at birth (P < .001). The most prominent factors associated with increased risks of hearing loss and visual impairment were intracranial hemorrhage and convulsions. VP (odds ratio [OR] 2.34; 95% confidence interval [CI] 1.75-3.14) and LP (OR 1.26; 95% CI 1.04-1.52) births were associated with an increased risk of hearing loss, and VP (OR 1.94; 95% CI 1.55-2.44), MP (OR 1.42; 95% CI 1.11-1.80), and LP (OR 1.31; 95% CI 1.16-1.49) births predicted an increased risk of visual impairment. Incidences of sensory impairment decreased with increasing GA at birth. The most prominent risk factors predictive of sensory disabilities were intracranial hemorrhage and convulsions. VP and LP births were associated with an increased risk of hearing loss, and VP, MP, and LP births were associated with an increased risk of visual impairment.

Outcomes of Implementation of a NICU-Based Late Preterm Infant Feeding Guideline.

Late preterm (LPT) infants are at risk for feeding difficulties. Our objectives were to reduce the use of intravenous (IV) fluids and increase breastfeeding at discharge among LPT infants admitted to our NICU. We implemented a feeding guideline and evaluated its effect using a pre-post design. We examined rates of our main outcomes, IV fluid use, and any or exclusive breastfeeding at discharge, as well as several secondary outcomes, including hypoglycemia (glucose <50 mg/dL) at >8 hours of life, by using χ2 and t tests. We excluded infants that were <2000 g, admitted to the NICU at >8 hours of life, or needed IV fluids at ≤8 hours of life for a medical reason. We used multivariable logistic regression to examine odds ratios and 95% confidence intervals of our main outcomes. Fifty percent of infants were eligible. Of those eligible, 18 of 52 (35%) vs 14 of 65 (22%) received IV fluids at >8 hours of life (P = .06). In the 24 hours before discharge, 35 of 52 (75%) vs 46 of 65 (78%) received any breast milk (P = .67), and 10 of 52 (30%) vs 10 of 65 (21%) received exclusive breast milk (P = .43). More infants had hypoglycemia in the posttime period (16 of 65 [25%]) compared with the pretime period (3 of 52 [6%]; P = .01). After implementation of a LPT feeding guideline in our NICU that defined specific expected feeding volumes, we did not find changes in IV fluid use or breastfeeding.

Association between the frequency of bedwetting and late preterm birth in children aged ≥5 years.

We examined the associations between late preterm (LPT) birth children aged ≥5 years and the frequency of bedwetting. Moreover, those who were born full-term/low birthweight (BW), LPT/low BW, LPT/normal BW and LPT/low BW were compared. In total, we evaluated 614 patients who underwent assessments for frequent bedwetting at the three hospitals from January 2014 to December 2016. Data at the initial visit were collected from the electronic medical records. We assessed the patients' bladder diaries and questionnaires containing detailed information on demographics and frequency of bedwetting per month. Neonatal data were collected from the Maternal and Child Health Handbook. Frequency of bedwetting in the LPT/low BW group was higher than in the term/low BW group (28 vs. 22.5, p < 0.05). However, the frequency between the LPT/normal BW group and the LPT/low BW group was not significantly different (28 vs. 28, p = 1.00). Multiple regression analyses were conducted to eliminate potential confounding factors, attention-deficit/hyperactivity disorder and intellectual disability, but results were not changed. This study revealed that LPT/low BW was associated with increased frequency of bedwetting in children. The results suggest that gestational age should be considered when examining patients with severe bedwetting.

Multi-parametric cardiorespiratory analysis in late-preterm, early-term, and full-term infants at birth.

Infants born at 35-37weeks' gestational age (GA) are at higher risk for a range of pathological conditions and poorer neurodevelopmental outcomes. However, mechanisms responsible are not fully understood. The purpose of this paper is to use traditional and novel techniques to assess newborn autonomic development as a function of GA at birth, focusing on cardiorespiratory regulation. ECG and respiration were acquired during sleep on 329 healthy newborns. Infants were divided into GA groups: 35-36weeks (late preterm (LPT)), 37-38weeks (early term (ET)), and 39-40weeks (full term (FT)). Time domain, frequency domain, and non-linear measures were calculated. Increased heart rateshort-term variability and complexity as a function of GA were observed in time domain and non-linear measures. Decreasing inter-breath interval variability was found as a function of GA, with increasing linear cardiorespiratory coupling. A complexity parameter (quadratic sample entropy) was less affected by arrhythmias and artifacts when compared to traditional measures. Results suggest lower maturation in LPT, with less developed cardiorespiratory regulation. This may confer risk for altered outcome, convergent with epidemiological findings. Reported examples show that a combination of methodological approaches can be beneficial to characterize autonomic maturation. Graphical abstract ᅟ.

Placenta in intrauterine fetal demise (IUFD): a comprehensive study from a tertiary care hospital

Background: Intrauterine fetal demise (IUFD) is an unpredictable and challenging obstetric complication. Its etiology is multifactorial with more than 60% attributed to the placental cause. The present study was done with a primary objective of understanding the placental lesions underlying IUFD.Methods: In this retrospective observational study, IUFD cases (>22 weeks) between January 2012 and September 2015 were collected from pathology database. The clinical details with ultrasound findings were collected from mother’s charts. The lesions were classified into (A) maternal vascular malperfusion (MVM) including retroplacental hematomas, (B) fetal vascular malperfusion (FVM), (C) inflammatory lesions, and (D) idiopathic. The contributor to fetal death was classified as direct, major, minor, unlikely, or unknown. Placental findings of fetal hypoxia were recorded.Results: The study included 100 cases of IUFD. The mean maternal age was 26 years (18–36 years). Primipara were 46. There were 65 early preterm (PT) (<34 weeks), 20 late PT (34 weeks to <37 weeks) and 15 term (>37 weeks) IUFD. The mean gestation age was 30 weeks. The ratio of male:female fetuses was 1:1.7. Relevant obstetric complications included preeclampsia (n = 39), intrauterine growth restriction (IUGR) (n = 7), pre-gestational diabetes (n = 7), bad obstetric history (n = 6), oligohydramnios (n = 5). The mean placental weight was 256 g. Maternal vascular malperfusion had the highest incidence (30%), followed by combined maternal and FVM (10%). Exclusive inflammatory lesions and FVM were seen in 12 and 6%, respectively. No cause was identified in 18%. Direct contributor to IUFD was identified in 51 cases and major, minor, unlikely contribution in 21, 11 and nine cases, respectively. In nine cases, it was unknown. Lesions indicating fetal hypoxia were noted in 35 cases. In both early and late PT, MVM featured more commonly (23 and 5%). In term placentas, the most common cause was idiopathic.Conclusions: Lesions of MVM were the most common cause of IUFD and served as a direct contributor to fetal demise.

Altered Cardiac Characteristics in Infants Born Late Preterm

Altered Cardiac Characteristics in Infants Born Late Preterm

Maternal risk factors and early neonatal outcome among late preterm and term neonates in a neonatal intensive care unit in Punjab, India

Background: Late preterm neonates (34 to 36 weeks 6/7 days) were considered as ‘near term’ as they appeared apparently mature and comparable to term neonates. Many studies have now reported significantly higher rates of morbidity and mortality among this group of neonates. This study aims to evaluate the maternal risk factors associated with and short-term outcome of late preterm neonates compared to term neonates.Methods: A Retrospective cohort study was conducted in the Neonatal Intensive Care Unit of a tertiary care teaching hospital. All intramural late preterm neonates with gestational age of 34-36 weeks born during the study period were enrolled. The control group included term neonates (37-42 weeks) born during the study period. Data regarding the maternal risk factors and neonatal outcomes for both the late preterm and term neonates were collected from records maintained in the NICU. Results: There were 3275 deliveries during the study period, of which 2447 (74.8%) were term. Among the 828 preterm neonates, 500 (60.4%) were late preterms. The maternal risk factors significantly associated with late preterm neonates were PIH, eclampsia, APH, multiple gestation, PROM, oligohydramnios and abnormal dopplers. Incidence of Respiratory distress syndrome (RDS), sepsis and hypoglycemia were higher among the late preterm group with an odd’s ratio of 56.01, 9.9 and 7.8 respectively. Incidence of hypocalcemia, seizures and Persistent Pulmonary Hypertension (PPHN) were also higher among this group. There was no statistically significant difference in mortality among the two groups.Conclusions: Late preterm neonates have a significantly higher neonatal morbidity compared to term neonates.

Gross Motor Outcomes of Children Born Prematurely in Northern Ontario and Followed by a Neonatal Follow-Up Programme.

Purpose: The developing brain of a premature infant is vulnerable to injury. As a result, the long-term consequences of a premature birth include motor deficits, cognitive and behavioural problems. It is crucial to identify motor dysfunction during the preschool period because it interferes with a child's ability to explore the world. The goals of this study were to (1) provide preliminary data on the gross motor outcomes of children born prematurely and (2) determine the proportion and characteristics of the children who had maintained delays over the course of follow-up. Method: A retrospective chart review was conducted on all infants monitored by a neonatal follow-up programme. Each child was assessed by a single physiotherapist from birth until age 2 years. Of the 107 cases identified, 97 individuals were retained for analysis; they had a mean gestational age of 31.1 (SD 2.9) weeks and a mean birth weight of 1.66 (SD 0.53) kilograms. Results: The majority of children assessed were found to have gross motor outcomes in the average range. Children with scores below the average range were most often born very preterm (VPT) or moderately preterm (MPT), with very low or low birth weight, respectively. A total of 17 participants were referred to physiotherapy to address the gross motor delays identified in the follow-up programme; 14 of these 17 had previously been identified as delayed and were being monitored. Late preterm (LPT) children (n=6) were most often referred, followed by those born extremely preterm (EPT) and VPT (n=4). In total, 56 children were identified as delayed at one assessment point but were found to be within normal limits by the end of the follow-up period. Conclusion: It is important to periodically monitor premature children. A longitudinal, population-based study is also needed to provide more data on the predictors and long-term motor outcomes of MPT and LPT children.

267 The impact of nicu admission on breastfeeding initation and continuation in late preterms in 36 u.s. states, 2000–2013

Purpose of studyTo compare the rates of breastfeeding (BF) initiation and continuation among mothers of late preterm infants (LPIs) who were cared for in a NICU versus those who were not cared for in a NICU (non-NICU).Methods usedData from the Pregnancy Risk Assessment Monitoring System (PRAMS) was

Study of congenital heart diseases in neonates

Background: Congenital heart disease defined as an abnormality in cardio circulatory structure or function that is mostly present at birth; even it is discovered much later. Recognition of congenital heart disease in newborn is important as this group abnormality constitutes a significant proportion of congenital malformation that present in the neonatal life, and their early detection is important for appropriate management and good outcome. Objectives of present study were to evaluate clinical profile and outcome of various CHDs identified during neonatal period and to study effect of paracetamol used for pharmacological closure of PDA in preterm neonates.Methods: The study was conducted prospectively in NICU, Dhiraj hospital, Department of Pediatrics and Neonatology from January 2016 to June 2017 (1.5 years span). Echocardiography screening of all neonates suspected of having CHD was done. Details of all neonates having CHD diagnosed by echocardiography were noted in the prescribed Performa and their incidence, clinical profile and outcome was studied.Results: Total 69 cases of CHD diagnosed by Echocardiography in neonatal period were studied. Incidence of CHD among neonates born at Dhiraj hospital was 8.48 per 1000 live birth. Male: female ratio of all CHD cases was 1.38:1. Risk of neonate with CHD is highest (18.18%) in extremely low birth weight neonates. Incidence of CHD was 4.08% in preterm &lt; 34 weeks, 3.47% in late preterms and 0.51% in full term neonates. 86.95% were diagnosed within first week of life. 26.09% babies had associated anomalies. Presenting problem of neonates was breathing difficulty 42 (60.87%), feeding difficulty 36 (52.17%) and cyanosis 5 (7.25%). 8 (11.59%) neonates were asymptomatic. The most common presenting sign was murmur 46 (75.71%). 56 (81.16%) had Acyanotic CHD and 13 (18.84%) had Cyanotic CHD. Amongst 56 (81.16%) Acyanotic CHD cases, commonest was PDA in 44 (78.5%), followed by VSD in 18 (32.14%), ASD in 5 (12.5%) either in isolation or in combination with other lesions. Amongst Cyanotic Congenital Heart Disease, maximum incidence was of Tricuspid Atresia (TA) in 4 (30.76%) cases; followed by TGA in 3 (23.07%). 20 preterm neonates with PDA received paracetamol for PDA closure. 9 (45.0%) responded to paracetamol while 11 (55%) did not respond. 47(68.12%) were discharged, 10(14.49%) went left against medical advice, 7(10.14%) were referred to higher centre for surgery and 5(7.25%) babies expired.Conclusions: Early recognition of congenital heart disease during neonatal life is important as its appropriate and timely management can result in good outcome.

Cerebral NIRS patterns in late preterm and very preterm infants becoming late preterm

Background Near Infrared Spectroscopy (NIRS) has been proposed as a useful, noninvasive monitoring technique providing reliable information about central nervous system (CNS) oximetry and function. Recently, brain damage has been reconsidered as a dynamic process evolving over the weeks of gestation. We therefore investigated NIRS cerebral pattern differences between healthy late preterm infants (LPTo) and very preterm infants becoming late preterm (LPT). Methods We conducted an observational study in 40 healthy late preterm infants, matched for gestational age at monitoring, of whom 20 where LPTo and 20 LPT. Clinical, diagnostic and laboratory monitoring procedures and cerebral oximetry (crSO2) and function (cFTOE) were recorded on admission into the study. Results No significant differences (p > .05, for all) were found between groups regarding clinical, diagnostic or laboratory parameters. Higher crSO2 and lower cFTOE (p < .001, for both) were found in the LPTo group. Conclusions Our results, showing impaired oximetry and function of CNS in LPT, offer additional support to NIRS parameters as a useful tool for longitudinal CNS monitoring of very preterm infants becoming LPT. Future studies correlating NIRS variables and long-term neurological outcome in LPT are needed to elucidate the concept of dynamic brain damage pathogenesis.

First Year of Israeli Newborn Screening for Severe Combined Immunodeficiency-Clinical Achievements and Insights.

Severe combined immunodeficiency (SCID), the most severe form of T cell immunodeficiency, is detectable through quantification of T cell receptor excision circles (TRECs) in dried blood spots obtained at birth. Herein, we describe the results of the first year of the Israeli SCID newborn screening (NBS) program. This important, life-saving screening test is available at no cost for every newborn in Israel. Eight SCID patients were diagnosed through the NBS program in its first year, revealing an incidence of 1:22,500 births in the Israeli population. Consanguine marriages and Muslim ethnic origin were found to be a risk factor in affected newborns, and a founder effect was detected for both IL7Rα and DCLRE1C deficiency SCID. Lymphocyte subset analysis and TREC quantification in the peripheral blood appear to be sufficient for confirmation of typical and leaky SCID and ruling out false positive (FP) results. Detection of secondary targets (infants with non-SCID lymphopenia) did not significantly affect the management or outcomes of these infants in our cohort. In the general, non-immunodeficient population, TREC rises along with gestational age and birth weight, and is significantly higher in females and the firstborn of twin pairs. Low TREC correlates with both gestational age and birth weight in extremely premature newborns. Additionally, the rate of TREC increase per week consistently accelerates with gestational age. Together, these findings mandate a lower cutoff or a more lenient screening algorithm for extremely premature infants, in order to reduce the high rate of FPs within this group. A significant surge in TREC values was observed between 28 and 30 weeks of gestation, where median TREC copy numbers rise by 50% over 2 weeks. These findings suggest a maturational step in T cell development around week 29 gestation, and imply moderate to late preterms should be screened with the same cutoff as term infants. The SCID NBS program is still in its infancy, but is already bearing fruit in the early detection and improved outcomes of children with SCID in Israel and other countries.

The incidence and risk factors of epilepsy in children born preterm: A nationwide register study

ObjectivesThe aim was to compare the incidence of epilepsy between very preterm (VP) (<32+0 weeks), moderately preterm (MP) (32+0–33+6 weeks), late preterm (LP) (34+0–36+6 weeks) and term infants (≥37 weeks) and to establish and compare risk factors of epilepsy in these groups. MethodsThe national register study included all live born infants in Finland in 1991–2008. Excluding infants with missing gestational age, a total of 1,033,349 infants were included in the analysis and they were analyzed in four subgroups (VP, MP, LP and term) and three time periods (1991–1995, 1996–2001 and 2002–2008). Results5611 (0.54%) children with epilepsy were diagnosed. The incidence of epilepsy was 2.53% in the VP, 1.08% in the MP, 0.75% in the LP and 0.51% in the term group. Intracranial hemorrhage (OR 3.48; 95% CI 2.47–4.89) and convulsions in the neonatal period (OR 13.4; 95% CI 10.2–17.6) were associated with an increased risk of epilepsy. Compared to the term group, preterm birth (VP OR 4.59; 95% CI 3.79–5.57, MP 1.97; 1.48–2.63, LP 1.44; 1.25–1.68) was associated with an increased risk of epilepsy after adjusting for maternal, pregnancy, delivery and sex variables. ConclusionsThe incidence of epilepsy decreased by advancing gestational age at birth and preterm birth predicted an increased risk of epilepsy in childhood. Intracranial hemorrhage and neonatal convulsions were strongly associated with an increased risk of epilepsy.

Physical Growth, Morbidity Profile and Mortality Among Healthy Late Preterm Neonates.

To compare the physical growth outcomes, morbidity profile and mortality at an age of 12 months among late preterm (34 0/7to 36 6/7) neonates to term (37 0/7to 41 6/7) neonates. Prospective cohort study. A tertiary care center of Northern India during 2014-2015. 200 apparently healthy late preterms and term infants, followed up to 12 months of age. Physical growth parameters, morbidity profile and mortality. At mean age of 12 months, mean (SD) weight, length and head circumference of late preterms were 7.4 (0.8) kg, 69.2 (2.5) cm and 43.0 (1.1) cm, respectively; which were significantly lower than that of the full term infants [8.7 (1.6) kg, 72.2 (3.1) cm and 44.2 (1.1) cm] (P< 0.001). On univariate analysis, late preterm group was associated with higher odds (95% CI) of being underweight [5.6 (3.4, 5.5)], stunted [3.5 (2.1, 5.8)] and wasted [3.6 (1.9, 6.9)]. On multivariate analysis, only adjusted odds of late preterms becoming underweight by one year was significant [OR 4.1; 95% CI (1.6, 10.4)]. Feeding difficulties, jaundice and re-hospitalization rates were significantly higher in the late preterm group. The median (IQR) episodes per baby for late preterms as compared to terms for diarrhea [1.84 (0,3) vs 1.14 (0,2) (P <0.001)], and fever [1.33 (0,2) vs. 0.95 (0,2) (P = 0.01)] were higher. Healthy late preterms are at significantly higher risk of being underweight in the first year of life, in addition to having significantly higher morbidity.

Screening for Hypoglycemia in Exclusively Breastfed High-risk Neonates.

To determine incidence of hypoglycemia in exclusively breastfed, high-risk but healthy newborns, and risk factors for its development. This observational study enrolled 407 exclusively breastfed high-risk (low birth weight newborns (1800-2499 g), late preterms, small-for-gestation, large-for-gestation and infant of diabetic mother), who did not require admission to neonatal intensive care unit and were kept in postnatal wards with mother. Hypoglycemia was defined as blood glucose £46 mg/dL (2.6 mmol/L). Blood glucose was monitored till 48 hours of life. 27% of the screened newborns developed hypoglycemia in first 48 hours. 31 (7.6%) developed recurrent (>2) episodes, 28 (6.8%) had moderate (<37mg/dL) while 8 (1.9%) developed symptomatic hypoglycemia. With increase in birthweight, risk of hypoglycemia reduced significantly (P=0.003). Hypoglycemia was observed more frequently in first 2 hours as compared to next 48 hours (P=0.0001). Low birth- weight, preterm gestation and male gender was significantly associated with increased risk of hypoglycemia. Healthy, high-risk exclusively breastfed newborns in postnatal wards need close monitoring for hypoglycemia in first 24 hrs of life.

Respiratory Hospitalizations and Rehospitalizations in Infants Born Late Preterm

The impact of late preterm (LPT) birth, born at 34-0/7 to 36-6/7, on respiratory morbidity beyond the neonatal period is still a subject of controversy. It is currently not yet established whether ...