pediatrics
Postterm Infants
Treatment of Postterm Infants
Treatment of complications Improved obstetric care over the past 2 decades has markedly decreased the number of infants delivered past 41 weeks of gestation, which has also decreased the incidence of meconium aspiration syndrome. Postterm and dysmature infants are at risk of hypoglycemia and should be monitored and managed accordingly. For infants with perinatal asphyxia, management depends on the severity of the disease process. Therapeutic hypothermia may help infants with moderate or severe encephalopathy who had severe acidosis at birth, a low Apgar score at ≥ 5 minutes, and/or a need for prolonged resuscitation. Neither the incidence nor the severity of Meconium Aspiration Syndrome is reduced by endotracheal suction at the time of delivery, regardless of the apparent viscosity of the fluid or the infant's level of activity, so endotracheal intubation should be reserved for infants who need ventilatory assistance or who seem to have obstruction of the airway caused by meconium. Infants with meconium aspiration syndrome may require assisted ventilation; Surfactant treatment does not decrease overall mortality but does reduce the likelihood of the need for treatment with Extracorporeal Membrane Oxygenation (ECMO) (ECMO), so surfactant is frequently used in infants with significant respiratory distress. ECMO is available in a relatively few neonatal centers and generally is reserved for infants ≥ 34 weeks of gestation with hypoxic respiratory failure refractory to conventional medical treatment. Persistent Pulmonary Hypertension of the Newborn is treated with supportive therapies and inhaled nitric oxide or other pulmonary vasodilators. 