Oxygen saturation and heart rate in healthy term and late preterm infants with delayed cord clamping

Blood oxygen in the fetus is substantially lower than in the newborn infant. In the minutes after birth, arterial oxygen saturation rises from around 50–60% to 90–95%. Initial respiratory efforts generate negative trans-thoracic pressures that drive liquid from the airways into the lung interstitium facilitating lung aeration, blood oxygenation, and pulmonary artery vasodilatation. Consequently, intra- (foramen ovale) and extra-cardiac (ductus arteriosus) shunting changes and the sequential circulation switches to a parallel pulmonary and systemic circulation. Delaying cord clamping preserves blood flow through the ascending vena cava, thus increasing right and left ventricular preload. Recently published reference ranges have suggested that delayed cord clamping positively influenced the fetal-to-neonatal transition. Oxygen saturation in babies with delayed cord clamping plateaus significantly earlier to values of 85–90% than in babies with immediate cord clamping. Delayed cord clamping may also contribute to fewer episodes of brady-or-tachycardia in the first minutes after birth, but data from randomized trials are awaited. Impact Delaying cord clamping during fetal to neonatal transition contributes to a significantly earlier plateauing of oxygen saturation and fewer episodes of brady-and/or-tachycardia in the first minutes after birth. We provide updated information regarding the changes in SpO2 and HR during postnatal adaptation of term and late preterm infants receiving delayed compared with immediate cord clamping. Nomograms in newborn infants with delayed cord clamping will provide valuable reference ranges to establish target SpO2 and HR in the first minutes after birth.

Breastfeeding Self-Efficacy and Its Relationship with Perceived Stress and Breastfeeding Performance in Iranian Mothers with Late Preterm Infants: A Prospective Study

Background: Late preterm infants suffer from several problems after birth, and the key factor in fighting these problems is effective breastfeeding. Objective: To determine breastfeeding self-efficacy and its relationship with perceived stress and assess breastfeeding performance in mothers with late preterm infants Methods: In this prospective study, 171 eligible nursing mothers with late preterm infants born in Alzahra Medical Center of Tabriz, Iran, were selected via convenience sampling. The Breastfeeding Self-Efficacy Scale-Short Form was employed to measure breastfeeding self-efficacy, and the 14-item Perceived Stress Scale was used to measure the perceived stress 24 hours after giving birth. When the child was 4 months old, breastfeeding performance was measured by the Standard Breastfeeding Performance Questionnaire. The data were analyzed by Pearson and Spearman’s correlation tests, independent t-test, one-way ANOVA, and multiple linear regression analysis. Results: The mean (standard deviation) of breastfeeding self-efficacy was 50.0 (7.8) with scores ranging from 13 to 65, and the mean (standard deviation) of perceived stress was 26.5 (8.8) with scores ranging from 0 to 56. The median (25-75 percentiles) of breastfeeding performance score equaled 2.0 (1.0 to 3.0) with scores ranging from 0 to 6. Based on multiple linear regression analysis and after adjusting the personal-social characteristics, by increasing the score of breastfeeding self-efficacy, perceived stress was significantly decreased (B=-0.1, 95%CI=-0.3 to 0.0). However, there was no statistically significant relationship between breastfeeding self-efficacy and breastfeeding performance (p=0.418). Conclusion: Due to the possibility of adjusting breastfeeding self-efficacy and its role in mothers’ perceived stress, developing proper strategies seems to be essential for enhancing breastfeeding self-efficacy.

The effects of betamethasone on clinical outcome of the late preterm neonates born between 34 and 36 weeks of gestation

Background Prenatal corticosteroid administration in preterm labor is one of the most important treatments available to improve neonatal outcomes; however, its beneficial effects on late preterm infants (after the 34th week of gestation) remained unknown. We aimed to assess the effects of betamethasone on the clinical condition of the late preterm infants born between 34 and 36 weeks of gestation. Methods This retrospective cohort study was performed on 100 consecutive infants born between 34 and 36 weeks of gestation and received betamethasone before delivery as the cases and 100 neonates with the same delivery conditions but without receiving betamethasone. All neonates were followed up within hospitalization to assess the neonatal outcome. Results The neonates receiving betamethasone suffered more from respiratory distress syndrome (49% versus 31%, p = 0.008, RR = 1.59 95% CI (1.12–2.27)) and requiring more respiratory support (71% versus 50%, p = 0.002, RR = 1.43 95% CI (1.13–1.80)) as compared to the control group. There was no difference between the two groups in other neonatal adverse events or death. Conclusion the use of betamethasone in the late preterm period (after 34 weeks of gestation) has no beneficial effects on lung maturity or preventing neonatal adverse outcomes, even may lead to increase the risk for RDS and requiring respiratory support.

Neurodevelopmental Status of Moderate to Late Preterm Infants at 6 Months Corrected Age

Background: Moderate Preterm (MP) and Late Preterm (LP) infants together comprise more than 80% of all prematurely born infants. Since last decade, there has been growing concern about Neurodevelopmental Abnormality (NDA) in these infants. This study was aimed to assess neurodevelopmental status of moderate to late preterm born neonates and to determine factors associated with adverse neurodevelopmental outcome in a tertiary hospital in Bangladesh. Materials and methods: In this prospective observational study 215 preterm (32 to <37 completed weeks gestation at birth) infants (107 MP and 108 LP) were enrolled from the Special Care Neonatal Unit (SCANU) Chittagong Medical College Hospital from June 2018 to May 2019. Neurodevelopmental assessment was done by Rapid Neurodevelopmental Assessment (RNDA) at 1, 3 and 6 months of Corrected Age (CA). Results: Of the 215 enrolled children, 63 (29.3%) attended all the 3 follow-up, 123 (57.2%) had incomplete follow-up or lost and 29 (13.5%) died. At final follow-up out of 63 infants 43 (68.3%) had no abnormality in all 8 domains of RNDA. Seven infants (11.1%) had abnormality in one domain and 13 (20.6%) had abnormality in more than one domain. Gross motor abnormality was most common abnormality (28.6%), followed by cognition (14.3%), vision (12.7%) and behavior (12.7%). Small for gestational age and lower birth weight were found to be independent predictive factors for NDA in moderate to late preterm infants. Conclusion: Study has shown that NDA persist till 6 months of CA in moderate to late preterm infants. It is important to closely monitor the neurodevelopmental status and provide early intervention in referred cases. Chatt Maa Shi Hosp Med Coll J; Vol.20 (2); July 2021; Page 50-54

Assessment of Thyroid Functions in Late Preterm Infants of Mothers on Antenatal Steroids

Purpose: The study examined the effect of antenatal steroids on thyroid functions in late preterm infants on the third to the seventh day of life. Patients and Methods: A comparative Cross-Sectional study was conducted on 75 neonates admitted to NICU in the first week of life. They were divided according to exposure to antenatal steroids into three groups. First group: exposed to complete course of ANS. Second group: exposed to partial course of ANS. The third group: not exposed to ANS. Serum samples were obtained from selected cases free T3, Free T4, and TSH levels in the third day of life, compared to the cut of levels currently available (the TSH reference range is (1.7 to 9.1 mU per L), T4 should be greater than( 10 mcg per dL). Using Eleusis and Cubase analyzers kits (Roche Diagnostics, Indianapolis, IN, USA) by ELISA (enzyme-linked immune sorbent assay) technique. Results: The study showed that there were significantly higher serum T4 levels in group 1 that was exposed to a complete course compared to group 2 (partial course) and 3 (Third group). There were no significant differences in serum TSH, T3 levels between groups. The current study found a decreased incidence of the ROP, NEC and BPD among group 1 as compared to the other two groups although was non statistically significant. In addition, the complete course of ANS had delayed the date of delivery (P=0.04) as compared to the partial course in the current study. Conclusion: Antenatal corticosteroids can influence thyroid function in late preterm infants as serum T4 was significantly higher in infants exposed to complete course compared to those who were exposed to partial course or did not receive antenatal corticosteroids.

Effects of a breastfeeding coaching program on growth and neonatal jaundice in late preterm infants in South Korea

Purpose: This study examined the effects of a breastfeeding coaching program for mothers on growth and neonatal jaundice in late preterm infants (LPIs).Methods: This was a quasi-experimental study (non-randomized intervention) with a time-series design. The study was conducted among 40 LPIs who were admitted to the neonatal intensive care unit of a university hospital in Daegu, South Korea. In the order of admission, the first 21 infants were assigned to the experimental group, and 19 were assigned to the control group. The intervention program consisted of home- based and web-based practical breastfeeding support education for mothers across a total of 5 sessions. Infant growth was measured using body weight, length, and head circumference, and neonatal jaundice was assessed using transcutaneous bilirubin levels.Results: The likelihood of breastfeeding for infants in the experimental group at 4 weeks after discharge was the same as on the day of discharge, whereas it steadily decreased in the control group. There were significant differences in head circumference between the groups. However, weight, length, and transcutaneous bilirubin levels did not show a significant group-time interaction.Conclusion: A formal breastfeeding coaching program should be considered in clinical settings and at home within the first few weeks postpartum.

Caffeine is a respiratory stimulant without effect on sleep in the short-term in late-preterm infants

Background Caffeine is widely used in preterm infants for apnea control. It has no effect on sleep in the only existing polysomnographic study including ten preterm infants Behavioral and polygraphic studies have conflicting results. Methods We studied 21 late-preterm infants at a median gestational age of 36 weeks. Polysomnography was performed twice, at baseline on day 1 and on the day after the onset of caffeine treatment (20 mg/kg loading and 5 mg/kg morning maintenance dose). Results Caffeine acted short term as a breathing stimulant with reduction of apneas, improved baseline SpO2 (p < 0.001), and decreased 95 percentile of end-tidal carbon dioxide level (p < 0.01). It also increased arousal frequency to SpO2 desaturations of more than 5% (p < 0.001). Caffeine did not affect sleep stage distribution, sleep efficiency, frequency of sleep stage transitions, appearance of REM periods, or the high number of spontaneous arousals. The median spontaneous arousal count was 18 per hour at baseline, and 16 per hour during caffeine treatment (p = 0.88). Conclusions In late-preterm infants, caffeine has a clear short-term respiratory stimulant effect, and it increases the arousal frequency to hypoxia. However, caffeine does not appear to act as a central nervous system stimulant, and it has no acute effect on sleep quality. Impact Effects of caffeine on sleep in preterm infants has previously been investigated with only one full polysomnographic study including ten preterm infants. The study showed no effect. The current study shows that caffeine acts short term as a respiratory stimulant and increases arousal frequency to hypoxia. Although a potent central nervous system (CNS) stimulant in adults, caffeine does not seem to have similar acute CNS effect in late-preterm infants. The onset of caffeine treatment has no short-term effect on sleep stage distribution, sleep efficiency, frequency of sleep stage transitions, appearance of REM periods, or the high number of spontaneous arousals.