Curriculum Vitae

Nama : Gatot Irawan S

Alamat : Jl Tlaga Bodas Raya 20 Semarang
Tlp : 08122877223

2
Pendidikan
- Dokter : 1988, FK UNDIP, Semarang
- Spesialis anak : 2000, FK UNDIP, Semarang:
- Konsultan : 2011

Fellowship di KK Women & Children Hospital, Singapore, 2006

Pekerjaan : Dr Pendidik Klinis Utama, Divisi Neonatologi FK Undip/RSUP dr Kariadi

Jabatan : Ketua KSM Kesehatan Anak RSUP dr Kariadi Semarang
Pangkat/ gol : IV/D

Trainer : Nasional Resusitasi Program, Poned, Ponek, BBLR, Stable

Kontributor / editor : Manajemen BBLR utk bidan; Panduan Poned; Ponek, Stable
Buku Ajar Neonatologi; SPM IDAI, Stabilisasi Bayi baru lahir
Organisasi saat ini
- IDI; IDAI (Satgas Imunisasi , UKK Perinatologi ): - Pengurus pusat Perinasia.
Late Preterm lnfants (LPIs),
What’s The Problem ?
Continuing Professional Development X ,2018

Gatot Irawan. S
Department of Pediatrics, Faculty of Medicine, Diponegoro University,
Dr. Kariadi General Hospital, Semarang

13 Mei 2018, Hotel Haris , Bandung

Out line

• Introduction
• Definition
• Mortality & Morbidity
• Lpi :a population at risk.
• During the birth hospitalization
• Long term Outcome
• Guidelines
• Summary
 The late preterm infants
• Infants born between 34 0/7 – 36 6/7 weeks
gestational age
• more than 70% of all preterm births
• more mature and stable than infants born at earlier
gestations.
• less physiologically and metabolically mature than
term infants
• More higher risk for morbidity and mortality than
infants born at term
• Critical period of growth and dedevelopment of the
fetal brain,lungs and other systems
• Optimal support to late premature infants may
improve survival and quality of life

Kugelman A, Colin AA, Late Preterm Infants: Near Term But Still in a Critical Developmental Time periode. Pediatrics 2013;132;741
Martin JA, Final data for 2012. National vital statistics reports : CDC, National Center for Health Statistics, National Vital Statistics System. 2013;62(9):1-87.
Engle Wa, “Late-preterm” infants: a population at risk. Pediatrics 2007, 120:1390-401.
Medoff-Cooper B Near-Term Infant advisory Panel. The AWHONN Near-Term Infant Initiative: J Obstet Gynecol Neonatal Nurs 2005; 34: 666-71.Raju TNK, : Optimizing care and outcome for
late-preterm (near-term) infants:. Pediatrics 2006, 118:1207-14.
Infants Born Late Preterm :
Engle WA, Neoreviews 2009
www.thelancet.com Vol 379 June 9, 2012

The WHO : preterm birth < 37 completed weeks : extremely preterm (<28 weeks), very preterm (28–<32 weeks), and moderate or late preterm (32–
<37 completed weeks of gestation; fi gure 1).
Weight for Gestational Age Affects the Mortality of Late Preterm Infants
Pulver LS ,Pediatrics 2009;123;e1072

Study Population
343 322 live newborns with GA > 34
weeks born in Utah (1999 - 2005.) ,
365 died in the first 28 days
(NMR 1.1 deaths / 1000 live births),
827 died in the first year
(IMR 2.4 deaths / 1000 live births).
What’s The Problem ?

“Late-preterm” infants: a population at risk.

During the birth hospitalization
• Feeding difficulties
• Hypoglycemia
• Jaundice
• Respiratory distress
• Apnea
• Temperature instability

Engle Wa,. Pediatrics 2007, 120:1390-401.

 Physiologic and Metabolic Immaturity of
Late Preterm Infants
During the birth hospitalization
Long-Term Outcome
• Hypothermia
• Developmental delays
• Respiratory distress
• Apnea
• School failures
• Hypoglycemia • Behavioral and social
• Hyperbilirubinemia and jaundice disabilities
• Feeding problems • Mortality
1. Respiratory Problem
Mechanisms Leading to Respiratory Problems
in Late Preterm Infants
Respiratory Problem
2. Hypoglycemia

The definition of hypoglycemia and the threshold for treatment and

continued management are controversial as well.
• A plasma glucose (Harris, et al) : 47 mg/dL (2.6 mmol/L)
• AAP (2011) : 45 mg/dL (2.5 mmol/L)
• Pediatric Endocrine Society (2015)the first 48 h
:50 mg/dL (2.8 mmol/L)
<48 hours : >50 mg/dL (>2.8 mmol/L)
>48 hours >60 mg/dL (>3.3 mmol/L)
 At-risk infants should be
fed by 1 hour of age and
screened 30
minutes after the feeding

FIGURE 1
Screening for and
management of
postnatal glucose
homeostasis in
LPT 34 –366⁄7
screen 0 –24 hours

Adamkin DH, COMMITTEE ON FETUS AND NEWBORN, AAP .Pediatrics 2011;127:575–579

 3. Jaundice
UDP-glucuronyltransferase activity
4. Feeding difficulties

Providing optimal nutritional support to LPIs

improve survival and quality of life

At risk of inadequate nutrient intake due to:

Immature gastrointestinal function
Immature neural function
Lower stamina
Lower oral-motor tone
 Primitive gut formed 4. Feeding difficulties
Gut rotation Feeding and Gastrointestinal

Structure
Villi Function
Digestive enzymes

Small intestine mature

Swallow
Function

Gastrointestinal motor activity

Organized motility

Nutritive sucking and swallowing

Post-menstrual age (wk)

The ontogenic timetable showing structural and functional gastrointestinal development Clin Perinatol 2000
1768 LPIs  592 requiring a nutritional support

• Late preterm infants are high risk of

requiring nutritional support during
hospital stay,
• BW ≤2000 g, GA 34 weeks, SGA
• develop a respiratory distress syndrome
and require a surgical intervention.
Need of nutritional support according to gestational age
The recommendations
for the late preterm infant include

1. Promotion of breastfeeding
2. Formula feeding
when mothers’ milk is not available
3. Enteral nutritional support
4. Use of parenteral nutrition support.
27
5. Neonatal Infection

Rate of EOS
by GA
Papulo 2011
aris.primadi@yahoo.co.id
Late Preterm Infants:
Still in a Critical
Developmental Time
Period
Brain weight 65% of that of
gyral and sulcal formation is incomplete.
Cortical volume increases by 50%
25% of cerebellar development

Changes in brain volume and maturation with increasing gestational age.

Kugelman A, Colin AA, Pediatrics 2013;132;741
A. Brain weight versus gestational age.
B. Myelination versus gestational age
Long-Term Neurodevelopmental Outcome
Kugelman A, Colin AA. Pediatrics. 2013

Long-Term Respiratory Outcome

Rates of respiratory morbidity diagnosed between the third and fifth year of life
by gestational age category and by single week of gestational age

Paediatric and Perinatal Epidemiology, 2016, 30, 67–75

Bivariate comparison of neonatal and early childhood respiratory morbidity to
early childhood diagnosis of asthma and bronchitis by gestational age categor
Childhood Respiratory Morbidity after Late Preterm and Early Term
Delivery: a Study of Medicaid Patients in South Carolina

• A total of 3476 LPI, 12 398 ETI, and 25 975 term infants

• Both LPI and ETI were associated with an increased risk for
• asthma (LPI: HR 1.24, 95% CI 1.10, 1.40; ETI: HR 1.12, 95% CI
1.06, 1.19),
• bronchitis (LPI: HR 1.15, 95% CI 1.00, 1.34; ETI: HR 1.13, 95% CI
1.05, 1.2)
at 3 to 5 years of age

• Late preterm infants and early term infants are at increased

risk for asthma and bronchitis.
PRACTICE GUIDELINES
In-Hospital Assessment and Care
Summary
Late preterm infants are born at 34–0/7 through 36–6/7 weeks
afterLMP
Such infants are premature physiologically, anatomically, and
metabolically.
late preterm infants have higher risks for acute medical complications,
mortality, and longterm disabilities than do term infants.
The risks associated with late preterm birth suggest the need for
strategies
to diagnose and manage complications during the birth hospitalization
and first weeks after birth
Thank You