Once our granddaughter was born by cesarean section at 35 4/7 weeks after premature rupture of membranes with a footling breech presentation, and she, our daughter, and her husband were fine, I breathed a sigh of relief. From the perspective of a father and grandfather who also happens to have been a neonatologist, PICU person, and hospitalist, the worst was over. Or so I thought. Once our granddaughter was able to maintain her temperature and her blood glucose, and the short, mild desaturations resolved (not requiring stimulation), and she began taking nipple feeds fairly consistently, we all could relax as she would be ready for discharge home any day. Our neonatal intensive care (NICU) team at Evanston Hospital did an excellent job of caring for everyone, especially our granddaughter and her mom, with all of the stresses, adjustments and anxieties of having a “late preterm infant” in the NICU.
As a parent, it has been difficult and challenging watching our daughter and her husband go through this experience, even with a late preterm infant. Our daughter is an ER veterinarian and she is conversant with the expectations and the ups and downs in her daughter’s clinical course. However, emotionally it is still difficult. Even though the NICU team was very good about updating our daughter and her husband at each visit, when our granddaughter was having her mild desaturations or her indirect hyperbilirubinemia, or even with her relatively slow progress with nippling her feedings, let alone learning to breastfeed, it was challenging. From an old neonatologist’s viewpoint, late preterm infants are much more than just “growers!”.
As a member of the editorial board of NeoReviews, I have also been following the clinical information about late preterm births, notably an article by Matthew Kardatzke, Rebecca Rose and Bill Engle entitled “Late Preterm and Early Term Birth: At-Risk Populations and Targets for Reducing Such Early Births.”1 TNK Raju, who was one of my mentors when I was a medical student at University of Illinois, has been writing a lot about this group of infants’ acute problems and their short term and long term outcomes.2 These have been very concerning, and all obstetricians, neonatologists and general pediatric providers should make ourselves acutely aware of all of the clinical aspects of these infants and their families. In the article by Kardatzke, Rose and Engle, the authors summarize all of the acute issues experienced by our granddaughter during her NICU stay, including the challenges of initiating breastfeeding in this group of infants (“It will take a little time but things will work out fine”. I remember saying this to my families. It seems like it is taking a long time and is very challenging for mom and baby). Watching a late preterm infant learn to nipple feed and then learn to latch and breastfeed has been enlightening.
I would encourage our readers to spend some time reviewing this paper and some of the others in the comprehensive bibliography of this paper about late preterm infants. In our case, our granddaughter needed to be delivered and her clinical course was only mildly eventful with temperature instability, hypoglycemia, mild desaturations not requiring stimulation, physiologic jaundice and, her greatest challenge, learning to nipple feed as she had not learned to breastfeed yet.
The delivery of these infants should not be a matter of convenience for any of the people involved, as there should be a definite clinical indication for early delivery. Once the baby has been delivered, close attention and a thoughtful decision as to where the infant should be admitted should be made, with the neonatologist involved in this decision. Granted, it is a challenge to be completely objective when it is your granddaughter who is involved, but I hope as a clinician, you will take the time to review this paper and others and be thoughtful when you get your next call from the obstetrician about the delivery of a “late preterm or near term infant”.
In addition, I suggest spending some time looking at the long-term outcomes of these infants as well, as I have not had that conversation with my daughter and her husband yet. There are some excellent, very current references for your (and my) review1.
References
- Kardatzke M, Rebecca Rose R, Engle W. Late preterm and early term birth: at risk populations and targets for reducing such early births. NeoReviews 2017;18 (5): e265-e276.
- Raju TNK, Higgins RD, Stark AR, Leveno KJ. Optimizing care and outcome for late-preterm (near term) infants: a summary of a workshop sponsored by the National Institute of Child Health and Human Development. Pediatrics 2006; 118(3):1207-1214.
