Respiratory support and feeding-milestones in small-for-gestational-age, 34-36 weeks preterm infants
Apple Libradilla1, Anjeline Bukhari1, Selphee Tang1,2
1Department of Pediatrics, Cumming School of Medicine, Alberta Children's Hospital Research Institute, University of Calgary, Calgary, AB, Canada.
Insights
Small-for-gestational-age (SGA) late-preterm infants (LPIs) have similar respiratory outcomes to appropriate-for-gestational-age (AGA) LPIs. However, SGA LPIs experience longer feeding and hospital stays, indicating unique physiological adaptations.
Area of Science:
- Neonatalogy
- Perinatology
- Pediatric Research
Background:
- Small-for-gestational-age (SGA) infants are a distinct subgroup of late-preterm infants (LPIs).
- SGA LPIs remain understudied regarding their specific morbidities and outcomes.
- This study focuses on comparing SGA and appropriate-for-gestational-age (AGA) LPIs.
Purpose of the Study:
- To investigate maternal and infant characteristics, respiratory and feeding outcomes, and length of hospital stay (LOS) in LPIs.
- To compare outcomes between SGA and AGA infants across different gestational age strata (34-36 weeks).
Main Methods:
- Retrospective analysis of 778 LPIs (662 AGA, 116 SGA) between 34-36 weeks gestational age.
- Subgroup analyses were performed for infants at 34-35 and 36 weeks gestation.
- Maternal factors, respiratory outcomes, feeding progression, and LOS were assessed.
Main Results:
- No significant difference in respiratory morbidities between SGA and AGA LPIs after adjusting for covariates.
- SGA infants were less likely to achieve full oral feeds (O-F) within 7 days (aOR 0.50).
- SGA infants had longer lengths of stay, both before and after achieving full O-F.
Conclusions:
- SGA and AGA LPIs exhibit similar respiratory morbidity profiles.
- SGA LPIs demonstrate delayed achievement of full O-F and longer LOS.
- Extended LOS in SGA LPIs may reflect physiological maturation and individualized care rather than delays requiring intervention.
Background:
Representing a distinct group among Late-Preterm-Infants (LPIs), small-for-gestational-age (SGA; birthweight <10th centile) infants remain vastly understudied.
Methods:
We investigated maternal and infant characteristics, respiratory and feeding outcomes, and length of hospital stay (LOS) at 34-36 weeks gestational age (GA), with subgroup analyses at 34-35 and 36 weeks, comparing appropriate-for-gestational-age (AGA, n = 662) and SGA (n = 116) infants (total n = 778).
Results:
Both pre-existing and gestational hypertension, multiple births, mode of delivery, incidence of respiratory insufficiency, and type of respiratory support varied significantly between the three stratified GA. After adjusting for covariates, there was no significant difference in respiratory morbidities between SGA and AGA. However, SGA infants were less likely to: 1) achieve full oral-feeds (O-F) within 7-days with adjusted Odds Ratio (aOR) of 0.50; 95% Confidence Interval (CI) 0.31-0.80; 2) be discharged home within 3-days of achieving full O-F (aOR of 0.62; 95% CI 0.40-0.95), and 3) discharged home in <14-days (aOR 0.41; 95% CI 0.25-0.64).
Conclusions:
In this retrospective analysis, SGA and AGA LPIs demonstrated similar respiratory morbidities. However, achievement of full O-F and LOS were longer in SGA LPIs and may in part, reflect appropriate physiological maturation and individualized care rather than a delay necessitating intervention.
Impact:
Small-for-gestational-age (SGA) infants represent a distinct and vulnerable subgroup among late-preterm infants (LPIs). However, their specific morbidities remain understudied. Respiratory outcomes were similar between SGA and appropriate-for-gestational-age (AGA) LPIs. Gestational-age stratification (34-36, 34-35 and 36-weeks) identified outcome differences such as the interval between achieving full oral-feeds (O-F) and discharge at 36 vs. 34-35-weeks gestation. Although SGA LPIs took longer to achieve full O-F, they still experienced longer length-of-stay even after reaching full O-F suggesting additional underlying physiological adaptations may be contributing to this delay. Other than birth weight, short-term morbidities were similar between SGA LPIs with and without fetal-growth-restriction.
Related Concept Videos
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
01:15Enteral Nutrition II: Nasointestinal and Gastrostomy Feeding
Nasointestinal Feeding
Nasointestinal feeding involves placing a tube through...
01:15Endotracheal Intubation I: Procedure
The ET tube comprises various components, including a standard adaptor to attach a bag-valve-mask (BVM) or ventilator, a cuff, a pilot balloon, and radiopaque markings along its length to measure the insertion distance. The tube sizes...
01:30Pneumonia V: Nursing management and Prevention
The nurse must practice strict medical asepsis and adhere to infection control guidelines to minimize healthcare-associated infections.
Enhance airway patency
Position the patient correctly to facilitate drainage of the affected lung segments. Manual or mechanical percussion and vibration can also be employed.
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management
01:28Pneumonia IV: Management
Bacterial Pneumonia Treatment
For bacterial pneumonia, antibiotics serve as the cornerstone of therapy. Initial treatment often begins with empirical antibiotics, tailored to the anticipated causative organism and adjusted based on culture results. Key antibiotic choices include: