Paeds Cases · fetal-neonatal-and-perinatal
Late-preterm infant: risks and corrected-age follow-up — OSCE
OSCE station: counselling parents of a 35-week late-preterm infant on why their baby is not yet ready for discharge, what the discharge criteria mean, and how follow-up will run in corrected age.
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MRCPCH ClinicalRACP DCE
Prompt
Parents of a 35-week infant on the postnatal ward at 24 hours are keen to go home. The baby is breastfeeding but tiring, has lost 6 per cent of birthweight, temperature is 36.3 degrees Celsius in an open cot, and bilirubin is approaching the gestational-age-specific phototherapy threshold. They ask why their baby, who 'looks almost full term', cannot be discharged.
Objectives
- Explain in plain language why a 35-week infant is late-preterm, not term, and why that matters even when the baby looks well. [1] [2]
- Explain the discharge-readiness criteria and why they must all be met before going home. [6]
- Reassure the family about bilirubin and feeding management using gestational-age-specific reasoning. [5]
- Outline the corrected-age follow-up plan and invite the family into shared understanding. [4]
References6ShowHide
- [1]Engle WA, Tomashek KM, Wallman C Late-preterm infants: a population at risk Pediatrics, 2007.PMID 18055691
- [2]Spong CY Defining term pregnancy: recommendations from the Defining Term Pregnancy Workgroup JAMA, 2013.PMID 23645117
- [3]Gyamfi-Bannerman C, Thom EA, Blackwell SC, Tita AT Antenatal Betamethasone for Women at Risk for Late Preterm Delivery N Engl J Med, 2016.PMID 26842679
- [4]Fenton TR, Kim JH A systematic review and meta-analysis to revise the Fenton growth chart for preterm infants BMC Pediatr, 2013.PMID 23601190
- [5]Bhutani VK, Stark AR, Lazzeroni LC, Poland R, Gourley GR Predischarge screening for severe neonatal hyperbilirubinemia identifies infants who need phototherapy J Pediatr, 2013.PMID 23043681
- [6]Huff K, Rose RS, Engle WA Late Preterm Infants: Morbidities, Mortality, and Management Recommendations Pediatr Clin North Am, 2019.PMID 30819344