Archives of Gynecology and Obstetrics

, Volume 286, Issue 3, pp 619–626 | Cite as

The underestimation of immaturity in late preterm infants

  • Lars Hellmeyer
  • Kathrin Herz
  • Bozena Liedtke
  • Peter Wohlmuth
  • Stephan Schmidt
  • Bernhard-Joachim Hackeloeer
Maternal-Fetal Medicine



Late preterm infants with gestational ages between \( 34\frac{0}{7} \) and \( 36\frac{6}{7} \) weeks are known to be at higher risk of mortality and morbidity than term newborns. This study aims to investigate the nature and frequency of neonatological complications in the late preterm population resulting in neonatal intensive care unit admissions as well as to draw obstetrical conclusions from the results.


Neonatological outcomes of 893 consecutively born late preterm infants were evaluated and classified by the frequency of occurrence in relation to potential maternal or fetal risk factors.


Out of 893 late preterm infants, 528 (59.1 %) required intensive neonatal care. The incidence of apnea and bradycardia, the occurrence of feeding difficulties and the requirement of continuous positive airway pressure (CPAP) were inversely proportional to gestational age (p < 0.001). Gestational diabetes of the mother was more frequently associated with hypoglycemia (p < 0.001), but showed a reduced risk of hypothermia (p < 0.001). Small for gestational age neonates had a significantly lower rate of respiratory disorders (p < 0.001), but were more often affected by feeding difficulties (p < 0.01). Normal vaginal delivery had a significant advantage with regard to the necessity of CPAP (p < 0.01) and the occurrence of feeding difficulties (p < 0.05). Infants born by cesarean section were at higher risk of hypoglycemia (p < 0.001), but at lower risk of hyperbilirubinemia (p < 0.001).


The high risk of a problematic neonatological outcome in late preterms requires fundamental reconsideration. All efforts to prolong a pregnancy should be made beyond the 34th week of gestation.


Obstetrics Late preterms Neonatological outcome Immaturity 



Neonatal intensive care unit


Continuous positive airway pressure


Birth weight over the 90th percentile


Small for gestational age; birth weight below the 10th percentile


Intrauterine growth restriction


Preterm premature rupture of membranes


Continuous positive airway pressure


Apnea and bradycardia


Respiratory disorder






Feeding difficulties




Use of antibiotics


Week of gestation


Gestational diabetes mellitus


Mode 1


Mode 2


Mode 3


  1. 1.
    McCormick MC (1985) The contribution of low birth weight to infant mortality and childhood morbidity. N Engl J Med 312:82–90PubMedCrossRefGoogle Scholar
  2. 2.
    Goldenberg RL, Rouse DJ (1998) The prevention of premature birth. N Engl J Med 339:313–320PubMedCrossRefGoogle Scholar
  3. 3.
    Goldenberg R, Culhane JF, Iams JD, Romero R (2008) Epidemiology and causes of preterm birth. Lancet 371:75–84PubMedCrossRefGoogle Scholar
  4. 4.
    Beinder E (2011) Impact of iatrogenic preterm birth on newborn morbidity. Z Geburtsh Neonatol 215:133–138CrossRefGoogle Scholar
  5. 5.
    Flood K, Malone FD (2012) Prevention of preterm birth. Semin Fetal Neonatal Med 17(1):58–63Google Scholar
  6. 6.
    Iams JD, Berghella V (2010) Care for women with prior preterm birth. Am J Obstet Gynecol 2:89–100CrossRefGoogle Scholar
  7. 7.
    Modena AB, Berghella V (2005) Antepartum management of multifetal pregnancies. Clin Perinatol 32(2):443–454PubMedCrossRefGoogle Scholar
  8. 8.
    Roman AS, Rebarber A, Pereira L, Sfakianaki AK, Berghella V (2005) The efficacy of sonographically indicated cerclage in multiple gestations. J Ultrasound Med 24(6):763–768PubMedGoogle Scholar
  9. 9.
    Fonseca EB, Celik E, Parra M, Singh M, Nicolaides KH, Fetal Medicine Foundation Second Trimester Screening Group (2007) Progesterone and the risk of preterm birth among women with a short cervix. N Engl J Med 357(5):462–469PubMedCrossRefGoogle Scholar
  10. 10.
    Norman JE, Mackenzie F, Owen P, Mactier H, Hanretty K, Cooper S, Calder A, Mires G, Danielian P, Sturgiss S, MacLennan G, Tydeman G, Thornton S, Martin B, Thornton JG, Neilson JP, Norrie J (2009) Progesterone for the prevention of preterm birth in twin pregnancy (STOPPIT): a randomised, double-blind, placebo-controlled study and meta-analysis. Lancet 373(9680):2034–2040PubMedCrossRefGoogle Scholar
  11. 11.
    Bujold E, Roberge S, Lacasse Y, Bureau M, Audibert F, Marcoux S, Forest JC, Giguère Y (2010) Prevention of preeclampsia and intrauterine growth restriction with aspirin started in early pregnancy: a meta-analysis. Obstet Gynecol 116(2):402–414PubMedCrossRefGoogle Scholar
  12. 12.
    Roberge S, Bujold E (2010) Uterine artery Doppler and low-dose aspirin to predict and prevent preeclampsia. BJOG 117(11):1430–1431PubMedCrossRefGoogle Scholar
  13. 13.
    AWMF-Guidelines (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe): Medikamentöse Hemmung bei drohender Frühgeburt, 8/2008.
  14. 14.
    Gyetvai K, Hannah ME, Hodnett ED, Ohlsson A (1999) Tocolytics for preterm labor: a systematic review. Obstet Gynecol 94(5):869–877PubMedCrossRefGoogle Scholar
  15. 15.
    Crowley P (2007) Interventions for preventing or improving the outcome of delivery at or beyond term. Cochrane Database Syst Rev 18(4):CD000170Google Scholar
  16. 16.
    Murphy KE, Hannah ME, Willan AR, Ohlsson A, Kelly EN, Matthews SG, Saigal S, Asztalos E, Ross S, Delisle MF, Tomat L, Amankwah K, Guselle P, Gafni A, Lee SK, Armson BA, MACS Collaborate Group (2011) Maternal side-effects after multiple courses of neonatal corticosteroids (MACS): the three-month follow-up of women in the randomized controlled trial of MACS for preterm birth study. J Obstet Gynaecol Can 33(9):909–921PubMedGoogle Scholar
  17. 17.
    Asztalos EV, Murphy KE, Hannah ME, Willan AR, Matthews SG, Ohlsson A, Kelly EN, Saigal S, Ross S, Delisle MF, Amankwah K, Guselle P, Gafni A, Lee SK, Armson BA, Sananes R, Tomat L (2010) Multiple courses of antenatal corticosteroids for preterm birth study: 2-year outcomes. Pediatrics 126(5):1045–1055CrossRefGoogle Scholar
  18. 18.
    Mohan SS, Jain L (2011) Late preterm birth: preventable prematurity? Clin Perinatol 38(3):547–555PubMedGoogle Scholar
  19. 19.
    Bettegowda VR, Dias T, Davidoff MJ, Damus K, Callaghan WM, Petrini JR (2008) The relationship between caesarean delivery and gestational age among US singleton births. Clin Perinatol 35(2):309–323PubMedCrossRefGoogle Scholar
  20. 20.
    Pulver LS, Guest-Warnick G, Stoddard G, Byington CL, Young PC (2009) Weight for gestational age affects the mortality of late preterm infants. Pediatrics 123:1072–1077CrossRefGoogle Scholar
  21. 21.
    Baschat A (2004) Doppler application in the delivery timing of the preterm growth-restricted fetus: another step in the right direction. Ultrasound Obstet Gynecol 23:111–118PubMedCrossRefGoogle Scholar
  22. 22.
    Baschat A, Cosmi E, Bilardo CM, Wolf H, Berg C, Rigano S, Germer U, Moyano D, Turan S, Hartung J, Bhide A, Müller T, Bower S, Nicolaides KH, Thilaganathan B, Gembruch U, Ferrazzi E, Hecher K, Galan HL, Harman CR (2007) Predictors of neonatal outcome in early-onset placental dysfunction. Obstet Gynecol 109(2):253–261PubMedCrossRefGoogle Scholar
  23. 23.
    Baschat A (2010) Fetal growth restriction—from observation to intervention. J Perinat Med 38:239–246PubMedCrossRefGoogle Scholar
  24. 24.
    GRIT Study Group (2003) A randomized trial of timed delivery for the compromised preterm fetus: short term outcomes and Bayesian interpretation. BJOG 110:27–32Google Scholar
  25. 25.
    Thornton JG, Hornbuckle J, Vail A, Spiegelhalter DJ, Levene M (2004) Infant wellbeing at 2 years of age in the Growth Restriction Intervention Trial (GRIT): multicentred randomised controlled trial. Lancet 364:513–520PubMedCrossRefGoogle Scholar
  26. 26.
    Lees C, Baumgartner H (2005) The TRUFFLE study—a collaborative publicly funded project from concept to reality: how to negotiate an ethical, administrative and funding obstacle course in the European Union. Ultrasound Obstet Gynecol 25:105–107PubMedCrossRefGoogle Scholar
  27. 27.
    Trial of umbilical and fetal flow in Europe (TRUFFLE): a multicentre randomised study. Assessed 11 January 2005
  28. 28.
    Froen JF, Gardosi JO, Thurmann A, Francis A, Stray-Pedersen B (2004) Restricted fetal growth in sudden intrauterine unexplained death. Acta Obstet Gynecol Scand 83:801–807PubMedGoogle Scholar
  29. 29.
    Catalano PM, Sacks DA (2011) Timing of indicated late preterm and early-term birth in chronic medical complications: diabetes. Semin Perinatol 35(5):297–301PubMedCrossRefGoogle Scholar
  30. 30.
    Dong Y, Yu JL (2011) An overview of morbidity, mortality and long-term outcome of late preterm. World J Pediatr. 7(3):199–204PubMedCrossRefGoogle Scholar
  31. 31.
    Swamy GK, Ostbye T, Skjaerven R (2008) Association of preterm birth with long-term survival, reproduction, and next-generation preterm birth. JAMA 284:843–849Google Scholar
  32. 32.
    Moster D, Lie RT, Markestad T (2008) Long-term medical and social consequences of preterm birth from infancy to adulthood. Lancet 371:261–269CrossRefGoogle Scholar
  33. 33.
    Nomura Y, Halperin JM, Newcorn JH, Davey C, Fifer WP, Savitz DA et al (2009) The risk for impaired learning-related abilities in childhood and educational attainment among adults born near-term. J Pediatr Psychol 34:406–418PubMedCrossRefGoogle Scholar
  34. 34.
    Huddy CL, Johnson A, Hope PL (2001) Educational and behavioural problems in babies of 32–35 weeks gestation. Arch Dis Child Fetal Neonatal Ed 85:23–28CrossRefGoogle Scholar
  35. 35.
    Kirkegaard I, Obel C, Hedegaard M, Henriksen TB (2006) GA and birth weight in relation to school performance of 10-year-old children: a follow-up-study of children born after 32 completed weeks. Pediatrics 118:1600–1606PubMedCrossRefGoogle Scholar
  36. 36.
    Morse SB, Zheng H, Tang Y, Roth J (2009) Early school-age outcomes of late preterm infants. Pediatrics 123:622–629CrossRefGoogle Scholar
  37. 37.
    Malloy MH (2009) Impact of cesarean section on intermediate and late preterm births: United States, 2000–2003. Birth 36(1):26–33PubMedCrossRefGoogle Scholar
  38. 38.
    Wang ML, Dorer DJ, Fleming MP et al (2004) Clinical outcome of near-term infants. Pediatrics 114:372–376PubMedCrossRefGoogle Scholar
  39. 39.
    Nelle M, Gerull R (2011) Iatrogenic preterm births and late preterm births of \( 34\frac{0}{7} \) to \( 36\frac{6}{7} \)—risk and chances. Z Geburtsh Neonatol 215:152–157CrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Lars Hellmeyer
    • 1
    • 5
  • Kathrin Herz
    • 2
  • Bozena Liedtke
    • 3
  • Peter Wohlmuth
    • 2
  • Stephan Schmidt
    • 4
  • Bernhard-Joachim Hackeloeer
    • 1
  1. 1.Department of Prenatal and Perinatal MedicineAsklepios ClinicHamburg-BarmbekGermany
  2. 2.Asklepios Proresearch DepartmentHamburgGermany
  3. 3.Department of NeonatologyAsklepios ClinicHamburg-BarmbekGermany
  4. 4.Department of Obstetrics and Perinatal MedicinePhilipps University MarburgMarburgGermany
  5. 5.MarburgGermany

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