Abstract
Purpose
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.
Methods
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.
Results
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).
Conclusions
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.
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Abbreviations
- NICU:
-
Neonatal intensive care unit
- CPAP:
-
Continuous positive airway pressure
- Perc90:
-
Birth weight over the 90th percentile
- SGA10:
-
Small for gestational age; birth weight below the 10th percentile
- IUGR:
-
Intrauterine growth restriction
- PPROM:
-
Preterm premature rupture of membranes
- CPAP:
-
Continuous positive airway pressure
- APNBRA:
-
Apnea and bradycardia
- RESP:
-
Respiratory disorder
- HYPOGLY:
-
Hypoglycemia
- HYPOTHERM:
-
Hypothermia
- FEEDDIFF:
-
Feeding difficulties
- HYPERBILI:
-
Hyperbilirubinemia
- ANTIBIOT:
-
Use of antibiotics
- GW:
-
Week of gestation
- GDM:
-
Gestational diabetes mellitus
- M1:
-
Mode 1
- M2:
-
Mode 2
- M3:
-
Mode 3
References
McCormick MC (1985) The contribution of low birth weight to infant mortality and childhood morbidity. N Engl J Med 312:82–90
Goldenberg RL, Rouse DJ (1998) The prevention of premature birth. N Engl J Med 339:313–320
Goldenberg R, Culhane JF, Iams JD, Romero R (2008) Epidemiology and causes of preterm birth. Lancet 371:75–84
Beinder E (2011) Impact of iatrogenic preterm birth on newborn morbidity. Z Geburtsh Neonatol 215:133–138
Flood K, Malone FD (2012) Prevention of preterm birth. Semin Fetal Neonatal Med 17(1):58–63
Iams JD, Berghella V (2010) Care for women with prior preterm birth. Am J Obstet Gynecol 2:89–100
Modena AB, Berghella V (2005) Antepartum management of multifetal pregnancies. Clin Perinatol 32(2):443–454
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):763–768
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):462–469
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):2034–2040
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):402–414
Roberge S, Bujold E (2010) Uterine artery Doppler and low-dose aspirin to predict and prevent preeclampsia. BJOG 117(11):1430–1431
AWMF-Guidelines (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe): Medikamentöse Hemmung bei drohender Frühgeburt, 8/2008. http://awmf.org/
Gyetvai K, Hannah ME, Hodnett ED, Ohlsson A (1999) Tocolytics for preterm labor: a systematic review. Obstet Gynecol 94(5):869–877
Crowley P (2007) Interventions for preventing or improving the outcome of delivery at or beyond term. Cochrane Database Syst Rev 18(4):CD000170
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):909–921
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):1045–1055
Mohan SS, Jain L (2011) Late preterm birth: preventable prematurity? Clin Perinatol 38(3):547–555
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):309–323
Pulver LS, Guest-Warnick G, Stoddard G, Byington CL, Young PC (2009) Weight for gestational age affects the mortality of late preterm infants. Pediatrics 123:1072–1077
Baschat A (2004) Doppler application in the delivery timing of the preterm growth-restricted fetus: another step in the right direction. Ultrasound Obstet Gynecol 23:111–118
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):253–261
Baschat A (2010) Fetal growth restriction—from observation to intervention. J Perinat Med 38:239–246
GRIT Study Group (2003) A randomized trial of timed delivery for the compromised preterm fetus: short term outcomes and Bayesian interpretation. BJOG 110:27–32
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 364:513–520
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 25:105–107
Trial of umbilical and fetal flow in Europe (TRUFFLE): a multicentre randomised study. http://www.thelancet.com/info/info.isa?n1=authorinfo&n2=Protocol+reviews&uid=27361. Assessed 11 January 2005
Froen JF, Gardosi JO, Thurmann A, Francis A, Stray-Pedersen B (2004) Restricted fetal growth in sudden intrauterine unexplained death. Acta Obstet Gynecol Scand 83:801–807
Catalano PM, Sacks DA (2011) Timing of indicated late preterm and early-term birth in chronic medical complications: diabetes. Semin Perinatol 35(5):297–301
Dong Y, Yu JL (2011) An overview of morbidity, mortality and long-term outcome of late preterm. World J Pediatr. 7(3):199–204
Swamy GK, Ostbye T, Skjaerven R (2008) Association of preterm birth with long-term survival, reproduction, and next-generation preterm birth. JAMA 284:843–849
Moster D, Lie RT, Markestad T (2008) Long-term medical and social consequences of preterm birth from infancy to adulthood. Lancet 371:261–269
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 34:406–418
Huddy CL, Johnson A, Hope PL (2001) Educational and behavioural problems in babies of 32–35 weeks gestation. Arch Dis Child Fetal Neonatal Ed 85:23–28
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 118:1600–1606
Morse SB, Zheng H, Tang Y, Roth J (2009) Early school-age outcomes of late preterm infants. Pediatrics 123:622–629
Malloy MH (2009) Impact of cesarean section on intermediate and late preterm births: United States, 2000–2003. Birth 36(1):26–33
Wang ML, Dorer DJ, Fleming MP et al (2004) Clinical outcome of near-term infants. Pediatrics 114:372–376
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 215:152–157
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Hellmeyer, L., Herz, K., Liedtke, B. et al. The underestimation of immaturity in late preterm infants. Arch Gynecol Obstet 286, 619–626 (2012). https://doi.org/10.1007/s00404-012-2366-7
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DOI: https://doi.org/10.1007/s00404-012-2366-7