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Early Outcomes in Babies Born Close to Term

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Emerging Topics and Controversies in Neonatology

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Abstract

Advances in obstetric and neonatal care over recent years, together, make up one of the most impressive success stories of modern medicine. We can now manage problems and complexities in the care of preterm and sick neonates that we would not have thought possible only a relatively small number of years ago. Survival and neurodevelopmental outcomes have improved enormously, and this is cause for celebration. The boundaries of viability in terms of the very smallest and most immature babies are seemingly ever flexible, and we continue to push them back, with reports of survival following birth at 22 weeks of gestation becoming more common, albeit with mixed outcomes. Yet, while we count our achievements in advancing care for the tiny proportion of babies who are born extremely preterm, have we somehow forgotten the much larger number of more mature babies?

For years, neonatal research has centred almost exclusively on the effects of very preterm birth; we have learnt much and the evidence base to guide our management of these babies is constantly increasing. In stark contrast, until recently, we knew almost nothing about babies born closer to “term”. The last decade, however, has seen some shift in focus. New and emerging evidence is challenging long and widely held beliefs, leading to a somewhat uneasy cognisance that we should probably look more closely at these more mature babies. This chapter will discuss the concept of gestational age as a continuum and the sometimes confusing terminology associated with birth closer to term. It will summarise recent research evidence with respect to the effects of gestational age at birth on outcomes in early life, highlight the gaps in current knowledge, explore the implications for clinical practice, and consider how we should respond to the challenges that this new evidence may present.

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References

  1. Costeloe KL, et al. Short term outcomes after extreme preterm birth in England: comparison of two birth cohorts in 1995 and 2006 (the EPICure studies). BMJ. 2012;345:e7976.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Vohr BR. Neurodevelopmental outcomes of extremely preterm infants. Clin Perinatol. 2014;41(1):241–55.

    Article  PubMed  Google Scholar 

  3. Wood NS, et al. Neurologic and developmental disability after extremely preterm birth. EPICure Study Group. N Engl J Med. 2000;343(6):378–84.

    Article  CAS  PubMed  Google Scholar 

  4. Boyle EM, et al. Neonatal outcomes and delivery of care for infants born late preterm or moderately preterm: a prospective population-based study. Arch Dis Child Fetal Neonatal Ed. 2015;100(6):F479–85.

    Article  PubMed  Google Scholar 

  5. Fleming PF, et al. A national survey of admission practices for late preterm infants in England. BMC Pediatr. 2014;14:150.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Demestre X. Late preterm, the forgotten infants: a personal perspective. Rev Chil Pediatr. 2017;88(3):315–7.

    Article  PubMed  Google Scholar 

  7. Paes B. Respiratory syncytial virus in otherwise healthy prematurely born infants: a forgotten majority. Am J Perinatol. 2018;35(6):541–4.

    Article  PubMed  Google Scholar 

  8. Patrick Bouvier Kennedy Biography. The Famous People. 2019. https://www.thefamouspeople.com/profiles/patrick-bouvier-kennedy-35151.php. Accessed 9 Jun 2019.

  9. Office for National Statistics. Gestation specific infant mortality 2013. Office for National Statistics; 2015.

    Google Scholar 

  10. Escobar GJ, Clark RH, Greene JD. Short-term outcomes of infants born at 35 and 36 weeks gestation: we need to ask more questions. Semin Perinatol. 2006;30(1):28–33.

    Article  PubMed  Google Scholar 

  11. Kramer MS, et al. The contribution of mild and moderate preterm birth to infant mortality. Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System. JAMA. 2000;284(7):843–9.

    Article  CAS  PubMed  Google Scholar 

  12. Engle WA. A recommendation for the definition of “late preterm” (near-term) and the birth weight-gestational age classification system. Semin Perinatol. 2006;30(1):2–7.

    Article  PubMed  Google Scholar 

  13. Raju TN. The problem of late-preterm (near-term) births: a workshop summary. Pediatr Res. 2006;60(6):775–6.

    Article  PubMed  Google Scholar 

  14. Brown HK, et al. Neonatal morbidity associated with late preterm and early term birth: the roles of gestational age and biological determinants of preterm birth. Int J Epidemiol. 2014;43(3):802–14.

    Article  PubMed  Google Scholar 

  15. Chan E, Quigley MA. School performance at age 7 years in late preterm and early term birth: a cohort study. Arch Dis Child Fetal Neonatal Ed. 2014;99(6):F451–7.

    Article  PubMed  Google Scholar 

  16. Engle WA. Morbidity and mortality in late preterm and early term newborns: a continuum. Clin Perinatol. 2011;38(3):493–516.

    Article  PubMed  Google Scholar 

  17. Kajantie E, et al. Adult outcomes of being born late preterm or early term—what do we know? Semin Fetal Neonatal Med. 2019;24(1):66–83.

    Article  PubMed  Google Scholar 

  18. King JP, Gazmararian JA, Shapiro-Mendoza CK. Disparities in mortality rates among US infants born late preterm or early term, 2003-2005. Matern Child Health J. 2014;18(1):233–41.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Quigley MA, et al. Early term and late preterm birth are associated with poorer school performance at age 5 years: a cohort study. Arch Dis Child Fetal Neonatal Ed. 2012;97(3):F167–73.

    Article  PubMed  Google Scholar 

  20. Boyle EM, et al. Effects of gestational age at birth on health outcomes at 3 and 5 years of age: population based cohort study. BMJ. 2012;344:e896.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Crump C, et al. Gestational age at birth and mortality in young adulthood. JAMA. 2011;306(11):1233–40.

    Article  CAS  PubMed  Google Scholar 

  22. Crump C, et al. Early-term birth (37-38 weeks) and mortality in young adulthood. Epidemiology. 2013;24(2):270–6.

    Article  PubMed  Google Scholar 

  23. Laptook A, Jackson GL. Cold stress and hypoglycemia in the late preterm (“near-term”) infant: impact on nursery of admission. Semin Perinatol. 2006;30(1):24–7.

    Article  PubMed  Google Scholar 

  24. Bhutani VK, Johnson L. Kernicterus in late preterm infants cared for as term healthy infants. Semin Perinatol. 2006;30(2):89–97.

    Article  PubMed  Google Scholar 

  25. Raju TN. Developmental physiology of late and moderate prematurity. Semin Fetal Neonatal Med. 2012;17(3):126–31.

    Article  PubMed  Google Scholar 

  26. Craighead DV, Elswick RK Jr. The influence of early-term birth on NICU admission, length of stay, and breastfeeding initiation and duration. J Obstet Gynecol Neonatal Nurs. 2014;43(4):409–21.

    Article  PubMed  Google Scholar 

  27. Harris DL, Weston PJ, Harding JE. Incidence of neonatal hypoglycemia in babies identified as at risk. J Pediatr. 2012;161(5):787–91.

    Article  CAS  PubMed  Google Scholar 

  28. Wang ML, et al. Clinical outcomes of near-term infants. Pediatrics. 2004;114(2):372–6.

    Article  PubMed  Google Scholar 

  29. Garg M, Devaskar SU. Glucose metabolism in the late preterm infant. Clin Perinatol. 2006;33(4):853–70; abstract ix-x.

    Article  PubMed  Google Scholar 

  30. BAPM. Identification and management of neonatal hypoglycaemia in the full term infant—a framework for practice. 2017.

    Google Scholar 

  31. McKinlay CJ, et al. Neonatal glycemia and neurodevelopmental outcomes at 2 years. N Engl J Med. 2015;373(16):1507–18.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Rozance PJ, Hay WW Jr. New approaches to management of neonatal hypoglycemia. Matern Health Neonatol Perinatol. 2016;2:3.

    Article  PubMed  PubMed Central  Google Scholar 

  33. McKinlay CJD, et al. Association of neonatal glycemia with neurodevelopmental outcomes at 4.5 years. JAMA Pediatr. 2017;171(10):972–83.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Kair LR, et al. The experience of breastfeeding the late preterm infant: a qualitative study. Breastfeed Med. 2015;10(2):102–6.

    Article  PubMed  Google Scholar 

  35. Radtke JV. The paradox of breastfeeding-associated morbidity among late preterm infants. J Obstet Gynecol Neonatal Nurs. 2011;40(1):9–24.

    Article  PubMed  PubMed Central  Google Scholar 

  36. Raju TN, et al. Optimizing care and outcome for late-preterm (near-term) infants: a summary of the workshop sponsored by the National Institute of Child Health and Human Development. Pediatrics. 2006;118(3):1207–14.

    Article  PubMed  Google Scholar 

  37. Goyal NK, Attanasio LB, Kozhimannil KB. Hospital care and early breastfeeding outcomes among late preterm, early-term, and term infants. Birth. 2014;41(4):330–8.

    Article  PubMed  Google Scholar 

  38. Adamkin DH. Feeding problems in the late preterm infant. Clin Perinatol. 2006;33(4):831–7; abstract ix.

    Article  PubMed  Google Scholar 

  39. Pierro J, et al. Factors associated with supplemental formula feeding of breastfeeding infants during postpartum hospital stay. Breastfeed Med. 2016;11:196–202.

    Article  PubMed  Google Scholar 

  40. Chantry CJ, et al. In-hospital formula use increases early breastfeeding cessation among first-time mothers intending to exclusively breastfeed. J Pediatr. 2014;164(6):1339–45 e5.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Boban M, Zakarija-Grkovic I. In-hospital formula supplementation of healthy newborns: practices, reasons, and their medical justification. Breastfeed Med. 2016;11:448–54.

    Article  PubMed  Google Scholar 

  42. Bystrova K, et al. Early contact versus separation: effects on mother-infant interaction one year later. Birth. 2009;36(2):97–109.

    Article  PubMed  Google Scholar 

  43. Jain S, Cheng J. Emergency department visits and rehospitalizations in late preterm infants. Clin Perinatol. 2006;33(4):935–45; abstract xi.

    Article  PubMed  Google Scholar 

  44. Oddie SJ, et al. Early discharge and readmission to hospital in the first month of life in the Northern Region of the UK during 1998: a case cohort study. Arch Dis Child. 2005;90(2):119–24.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Johnson S, et al. Neurodevelopmental outcomes following late and moderate prematurity: a population-based cohort study. Arch Dis Child Fetal Neonatal Ed. 2015;100(4):F301–8.

    Article  PubMed  Google Scholar 

  46. Kerstjens JM, et al. Neonatal morbidities and developmental delay in moderately preterm-born children. Pediatrics. 2012;130(2):e265–72.

    Article  PubMed  Google Scholar 

  47. Kerstjens JM, et al. Developmental delay in moderately preterm-born children at school entry. J Pediatr. 2011;159(1):92–8.

    Article  PubMed  Google Scholar 

  48. Talge NM, et al. Late-preterm birth and its association with cognitive and socioemotional outcomes at 6 years of age. Pediatrics. 2010;126(6):1124–31.

    Article  PubMed  Google Scholar 

  49. Consortium on Safe Labor. Respiratory morbidity in late preterm births. JAMA. 2010;304(4):419–25.

    Article  Google Scholar 

  50. Mahoney AD, Jain L. Respiratory disorders in moderately preterm, late preterm, and early term infants. Clin Perinatol. 2013;40(4):665–78.

    Article  PubMed  Google Scholar 

  51. Natile M, et al. Short-term respiratory outcomes in late preterm infants. Ital J Pediatr. 2014;40:52.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Parikh LI, et al. Neonatal outcomes in early term birth. Am J Obstet Gynecol. 2014;211(3):265 e1–265 e11.

    Article  Google Scholar 

  53. Robinson S, et al. Respiratory outcomes in late and moderately preterm infants: results from a population-based study. J Pediatr Neonatal Individ Med. 2015;4(2):19–20.

    Google Scholar 

  54. Deshpande S, et al. Surfactant therapy for early onset pneumonia in late preterm and term neonates needing mechanical ventilation. J Clin Diagn Res. 2017;11(8):SC09–12.

    PubMed  PubMed Central  Google Scholar 

  55. Suresh GK, Soll RF. Overview of surfactant replacement trials. J Perinatol. 2005;25(Suppl 2):S40–4.

    Article  CAS  PubMed  Google Scholar 

  56. Isayama T, et al. Health services use by late preterm and term infants from infancy to adulthood: a meta-analysis. Pediatrics. 2017;140(1):e20170266.

    Article  PubMed  Google Scholar 

  57. Kotecha SJ, Dunstan FD, Kotecha S. Long term respiratory outcomes of late preterm-born infants. Semin Fetal Neonatal Med. 2012;17(2):77–81.

    Article  PubMed  Google Scholar 

  58. Kotecha SJ, Gallacher DJ, Kotecha S. The respiratory consequences of early-term birth and delivery by caesarean sections. Paediatr Respir Rev. 2016;19:49–55.

    PubMed  Google Scholar 

  59. Kotecha SJ, et al. Effect of early-term birth on respiratory symptoms and lung function in childhood and adolescence. Pediatr Pulmonol. 2016;51(11):1212–21.

    Article  PubMed  Google Scholar 

  60. Kotecha SJ, et al. Effect of late preterm birth on longitudinal lung spirometry in school age children and adolescents. Thorax. 2012;67(1):54–61.

    Article  PubMed  Google Scholar 

  61. McGowan JE, et al. Impact of neonatal intensive care on late preterm infants: developmental outcomes at 3 years. Pediatrics. 2012;130(5):e1105–12.

    Article  PubMed  Google Scholar 

  62. Engle WA, Kominiarek MA. Late preterm infants, early term infants, and timing of elective deliveries. Clin Perinatol. 2008;35(2):325–41, vi.

    Article  PubMed  Google Scholar 

  63. ACOG. ACOG committee opinion no. 561: nonmedically indicated early-term deliveries. Obstet Gynecol. 2013;121(4):911–5.

    Article  Google Scholar 

  64. van der Ham DP, et al. Management of late-preterm premature rupture of membranes: the PPROMEXIL-2 trial. Am J Obstet Gynecol. 2012;207(4):276 e1–10.

    Article  Google Scholar 

  65. Morris JM, et al. Immediate delivery compared with expectant management after preterm pre-labour rupture of the membranes close to term (PPROMT trial): a randomised controlled trial. Lancet. 2016;387(10017):444–52.

    Article  PubMed  Google Scholar 

  66. Boers KE, et al. Induction versus expectant monitoring for intrauterine growth restriction at term: randomised equivalence trial (DIGITAT). BMJ. 2010;341:c7087.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  67. Rabinovich A, et al. Late preterm and early term: when to induce a growth restricted fetus? A population-based study. J Matern Fetal Neonatal Med. 2018;31(7):926–32.

    Article  PubMed  Google Scholar 

  68. Gyamfi-Bannerman C, et al. Antenatal betamethasone for women at risk for late preterm delivery. N Engl J Med. 2016;374:1311–20.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  69. Doyle LW, et al. Early (< 8 days) systemic postnatal corticosteroids for prevention of bronchopulmonary dysplasia in preterm infants. Cochrane Database Syst Rev. 2017;10:CD001146.

    PubMed  Google Scholar 

  70. Kamath-Rayne BD, et al. Antenatal corticosteroids beyond 34 weeks gestation: what do we do now? Am J Obstet Gynecol. 2016;215(4):423–30.

    Article  CAS  PubMed  Google Scholar 

  71. Crowther CA, Harding JE. Antenatal glucocorticoids for late preterm birth? N Engl J Med. 2016;374(14):1376–7.

    Article  CAS  PubMed  Google Scholar 

  72. Battarbee AN, et al. Practice variation in antenatal steroid administration for anticipated late preterm birth: a physician survey. Am J Perinatol. 2019;36(2):200–4.

    Article  PubMed  Google Scholar 

  73. Rogers CE, Lenze SN, Luby JL. Late preterm birth, maternal depression, and risk of preschool psychiatric disorders. J Am Acad Child Adolesc Psychiatry. 2013;52(3):309–18.

    Article  PubMed  PubMed Central  Google Scholar 

  74. Tully KP, et al. The relationship between infant feeding outcomes and maternal emotional well-being among mothers of late preterm and term infants: a secondary, exploratory analysis. Adv Neonatal Care. 2017;17(1):65–75.

    Article  PubMed  PubMed Central  Google Scholar 

  75. Khan KA, et al. Economic costs associated with moderate and late preterm birth: a prospective population-based study. BJOG. 2015;122(11):1495–505.

    Article  CAS  PubMed  Google Scholar 

  76. Petrou S. Health economic aspects of late preterm and early term birth. Semin Fetal Neonatal Med. 2019;24(1):18–26.

    Article  PubMed  Google Scholar 

  77. Iacobelli S, et al. Gestational age and 1-year hospital admission or mortality: a nation-wide population-based study. BMC Pediatr. 2017;17(1):28.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Kuzniewicz MW, et al. Hospital readmissions and emergency department visits in moderate preterm, late preterm, and early term infants. Clin Perinatol. 2013;40(4):753–75.

    Article  PubMed  Google Scholar 

  79. Paranjothy S, et al. Gestational age, birth weight, and risk of respiratory hospital admission in childhood. Pediatrics. 2013;132(6):e1562–9.

    Article  PubMed  Google Scholar 

  80. Potijk MR, et al. Behavioural and emotional problems in moderately preterm children with low socioeconomic status: a population-based study. Eur Child Adolesc Psychiatry. 2015;24(7):787–95.

    Article  PubMed  Google Scholar 

  81. Potijk MR, et al. Developmental delay in moderately preterm-born children with low socioeconomic status: risks multiply. J Pediatr. 2013;163(5):1289–95.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Health Sciences, University of Leicester, Leicester, UK

    Elaine M. Boyle

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  1. Elaine M. Boyle
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Correspondence to Elaine M. Boyle .

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Editors and Affiliations

  1. Department of Health Sciences, George Davies Centre for Medicine, University of Leicester, Leicester, UK

    Elaine M. Boyle

  2. Department of Health Sciences, George Davies Centre for Medicine, University of Leicester, Leicester, UK

    Jonathan Cusack

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Boyle, E.M. (2020). Early Outcomes in Babies Born Close to Term. In: Boyle, E., Cusack, J. (eds) Emerging Topics and Controversies in Neonatology. Springer, Cham. https://doi.org/10.1007/978-3-030-28829-7_22

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  • DOI: https://doi.org/10.1007/978-3-030-28829-7_22

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