Optimizing Care and Outcomes for Late Preterm Neonates
The goal of this review is to define gestational age categories and discuss the epidemiology, complications, strategies for prevention, and management of late preterm infants. Late preterm (i.e., 34 to 36 weeks of gestation) birth is prevalent (8.0% of all live births in the USA in 2013) and is associated with increased infant mortality and morbidity. Although most late preterm births are medically indicated, elective early delivery plays a role. Policies limiting elective births at gestations less than 39 weeks and guidance for timing of indicated late preterm birth have reduced late preterm births. Late preterm neonates frequently require neonatal intensive care and should be monitored throughout life for developmental, educational, psychosocial, and medical morbidities. Prevention of late preterm births is key to reduction in mortality and morbidity. Continued prevention efforts and implementation of best practices may decrease acute and long-term complications of late preterm birth.
KeywordsLate preterm Morbidity Mortality Prevention Readmission
Compliance with Ethical Standards
Conflict of Interest
Rebecca Rose declares that she has no conflict of interest.
William A. Engle declares that he has no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
References and Recommended Reading
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 7.World Health Organization. Preterm birth. www.who.int. Accessed 8.8.16
- 9.Matthews TJ, MacDorman MF, Thoma ME. Infant mortality statistics from the 2013 period linked birth/infant death data set. National Vital Statistics Reports 64(9). National Center for Health Statistics.: Hyattsville, MD; 2015.Google Scholar
- 11.Mathews TJ, MacDorman MF. Infant mortality statistics from the 2006 period linked birth/infant death data set. National Vital Statistic Reports; vol 58 no 17. Hyattsville, MD: National Center for Health Statistics, 2010.Google Scholar
- 16.• Boyle EM, Johnson S, Manktelow, et al. Neonatal outcomes and delivery of care for infants born later preterm or moderately preterm: a prospective population-based study. Arch Dis Child Fetal Neonatal Ed. 2015;100:F479–85. Significance: Knowledge that late preterm infants managed in normal nursery sites require significantly more intervention than term infants is important for planning for service needs.CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Lapillonne A. Feeding the preterm infant after discharge. In Koletzko B, Poindexter B, Uauy R (editors) Nutritional Care of Preterm Infants: Scientific Basis and Practical Guidelines. World Rev Nutr Diet. Basel, Karger, 2014:110:264–277Google Scholar
- 38.• Kelly CE, Cheong JLY, Fam LG, et al. Moderate and late preterm infants exhibit widespread brain white matter microstructure alterations at term-equivalent age relative to term-born controls. Brain Imaging Behav. 2016;10(1):41–9. Significance: Impact of late preterm birth on white matter development in the brain.CrossRefPubMedGoogle Scholar
- 39.•Degnan AJ, Wisnowski JL, Choi S, et al. Altered structural and functional connectivity in late preterm preadolescence: an anatomic seed-based study of resting state networks related to the posteromedial and lateral parietal cortex. PLoS One. 2015;10(6):3130686. Significance: Negative impact on brain development of late preterm birth in preadolescent children.CrossRefGoogle Scholar
- 55.• Newnham JP, Dickinson JE, Hart RJ, Pennell CE, Arrese CA, Keelan JA. Strategies to prevent preterm birth. Front Immunol. 2014;584(5):1–12. Significance: Informative review of interventions to reduce late preterm birth.Google Scholar
- 56.Simhan HN, Berghella V, Iams JD. Preterm labor and birth. In: Creasy RK, Resnik R, Iams JD, Lockwood CJ, Moore TR, Greene MF, editors. Creasy and Resnik’s maternal-fetal medicine. 7th ed. PA.: Elsevier Saunders Philadelphia; 2014. p. 624–53.Google Scholar
- 57.Robinson JN, Norwitz ER, Lockwood CJ, Barss VA. Preterm birth: risk factors and interventions for risk reduction. UpToDate. www.uptodate.com. Accessed 8.10.2016.
- 58.Hamilton BE, Martin JA, Osterman MJK, et al. Births: final data for 2014. National vital statistics reports; vol 64 no 12. Hyattsville, MD: National Center for Health Statistics. 2015.Google Scholar
- 60.Clark SL, Frye DR, Meyers JA, et al. Reduction in elective delivery at < 39 weeks of gestation: comparative effectiveness of 3 approaches to change and the impact on neonatal intensive care admission and stillbirth. Am J Obstet Gynecol. 2010;203(449):e441–6.Google Scholar