Neonatal morbidity of late preterm compared with early term neonates

Nuno Lourenço, Marco Fernandes, Clara Gomes, Cristina Resende

Abstract


DOI: 10.15448/1980-6108.2017.1.25876

Aims: To evaluate and compare neonatal morbidity between late-preterm infants (LPTI) and early term infants (ETI).

Methods: Retrospective cross-sectional study, including live births at a regional referral maternity hospital in Portugal, in the years 2014 and 2015, with gestational age between 340/7 and 386/7 weeks. LPTI (340/7-366/7 weeks) were considered as cases and ETI (370/7-386/7 weeks) were considered controls. Neonates with congenital malformations, lack of prenatal care and hospitalization for social/maternal reasons were excluded. We evaluated and compared neonatal morbidity between the two groups, using Student's t-test for comparison between means (continuous variables) and Chi-square or Fisher's test for comparison between categorical variables. Odds ratio (OR) was calculated and adjusted (aOR) to birth weight, maternal disease, type of birth and multiple pregnancy. A value of p <0,05 was considered of statistical significance.

Results: A total of 1,745 neonates were evaluated: 324 cases (LPTI) and 1,421 controls (ETI). LPTI was associated with a higher frequency of maternal hypertension and gestational diabetes and higher rates of twinning and cesarean section. LPTI also had a higher risk for resuscitation (OR = 2.0 - 95%CI 1.3-3.0); hypoglycemia (aOR = 4.9 - 95%CI 2.9-8.2); hyperbilirubinemia (aOR = 4.8 - 95%CI 3.7-6.2), transient tachypnea (aOR = 6.4 - 95%CI 4.0-10.3); eating difficulties (aOR = 6.6 - 95%CI 4.8-8.9); sepsis (aOR = 4.4 - 95%CI 4.8-8.9); hospital stay ≥5 days (aOR = 8.6 - 95%CI 6.6-11.3); and lower exclusive breastfeeding rate (aOR = 0.2 - 95%CI 0.15-0.3).

Conclusions: In comparison to ETI, LPTI presented a higher risk of morbidity. This study reinforces the need for appropriate clinical follow-up of LPTI in the neonatal period.


Keywords


infant, newborn; infant, premature; morbidity.

References


World Health Organization. ICD-10: International statistical classification of diseases and related health problems, 10th revision. Geneva: WHO; 2004

Engle WA, Tomashek KM, Wallman C. "Late-Preterm" Infants: A Population at Risk. Pediatrics. 2007;120(6):1390-401. https://doi.org/10.1542/peds.2007-2952

Barros J, Clode N, Graca L. Prevalence of Late Preterm and Early Term Birth in Portugal. Acta Med Port. 2016;29(4):249-53. https://doi.org/10.20344/amp.6523

Raju TNK, Higgins RD, Stark AR, Leveno KJ. 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. https://doi.org/10.1542/peds.2006-0018

American College of Obstetricians and Gynecologists. Definition of term pregnancy. Committee Opinion Nº 579. Obstet Gynecol. 2013(122):1139-40. https://doi.org/10.1097/01.AOG.0000437385.88715.4a

Tita ATN, Landon MB, Spong CY, Lai Y, Leveno KJ, Varner MW, et al. Timing of Elective Repeat Cesarean Delivery at Term and Neonatal Outcomes. N Engl J Med. 2009;360(2):111-20. https://doi.org/10.1056/NEJMoa0803267

Engle WA. Morbidity and mortality in late preterm and early term newborns: A continuum. Clin Perinatol. 2011;38(3):493-516. https://doi.org/10.1016/j.clp.2011.06.009

Escobar GJ, Clark RH, Greene JD. Short-Term Outcomes of Infants Born at 35 and 36 Weeks Gestation: We Need to Ask More Questions. Seminars in Perinatology. 2006;30(1):28-33. https://doi.org/10.1053/j.semperi.2006.01.005

Machado Júnior LC, Passini Júnior R, Rodrigues Machado Rosa I. Late prematurity: a systematic review. J Pediatr (Rio J). 2014;90(3):221-31. https://doi.org/10.1016/j.jped.2013.08.012

Teune MJ, Bakhuizen S, Gyamfi Bannerman C, Opmeer BC, van Kaam AH, van

Wassenaer AG, Morris JM, Mol BW. A systematic review of severe morbidity in infants born late preterm. Am J Obstet Gynecol. 2011;205(4):374.e1-.e9. https://doi.org/10.1016/j.ajog.2011.07.015

Gkentzi D, Dimitriou G. Long-Term Outcome of Infants Born Late Preterm. Curr Pediatr Rev. 2014;10(4):263-7. https://doi.org/10.2174/1573400510666141114224257

Direção Geral de Saúde. Programa de vigilância epidemiológica da infeção nosocomial em unidades de cuidados intensivos neonatais [Internet]. Lisboa: DGS; 2007 [cited November 2016]. Available from: https://www.dgs.pt/programa-nacional-de-controlo-da-infeccao/ficheiros-de-upload/ucin-protocolo-pdf.aspx

Executive summary: Neonatal encephalopathy and neurologic outcome, second edition. Report of the American College of Obstetricians and Gynecologists' Task Force on Neonatal Encephalopathy. Obstet Gynecol. 2014;123(4):896-901. https://doi.org/10.1097/01.AOG.0000445580.65983.d2

Okumura A, Kidokoro H, Shoji H, Nakazawa T, Mimaki M, Fujii K, et al. Kernicterus in preterm infants. Pediatrics. 2009;123(6):e1052-8. https://doi.org/10.1542/peds.2008-2791

National Collaborating Centre for Women's and Children's Health. NICE Clinical Guidelines, No. 98: Neonatal Jaundice [Internet]. London: RCOG Press; 2010 [cited November 2016]. Available from: http://www.ncbi.nlm.nih.gov/books/NBK65119

Volpe JJ. Intracranial hemorrhage: germinal matrix-intraventricular hemorrhage of the premature infant. In: JJ Volpe, editors. Neurology of the newborn. 5th ed. Philadelphia: Saunders/Elsevier; 2008. p 517-588.

Fenton TR. A new growth chart for preterm babies: Babson and Benda's chart updated with recent data and a new format. BMC Pediatr. 2003;3:13. https://doi.org/10.1186/1471-2431-3-13

Dong Y, Yu J-L. An overview of morbidity, mortality and long-term outcome of late preterm birth. World J Pediatr. 2011;7(3):199-204. https://doi.org/10.1007/s12519-011-0290-8

Horgan MJ. Management of the Late Preterm Infant: Not Quite Ready for Prime Time. Pediatr Clin North Am. 2015;62(2):439-51. https://doi.org/10.1016/j.pcl.2014.11.007

Brown HK, Speechley KN, Macnab J, Natale R, Campbell MK. 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. https://doi.org/10.1093/ije/dyt251

Ward M, Deshpande S. Metabolic adaptation at birth. Semin Fetal Neonatal Med. 2005;10(4):341-50. https://doi.org/10.1016/j.siny.2005.04.001

Sarici SÜ, Serdar MA, Korkmaz A, Erdem G, Oran O, Tekinalp G, et al. Incidence, Course, and Prediction of Hyperbilirubinemia in Near-Term and Term Newborns. Pediatrics. 2004;113(4):775-80. https://doi.org/10.1542/peds.113.4.775

Chan E, Leong P, Malouf R, Quigley MA. Long-term cognitive and school outcomes of late-preterm and early-term births: a systematic review. Child Care Health Dev. 2016;42(3):297-312. https://doi.org/10.1111/cch.12320

Gill J, Boyle E. Outcomes of infants born near term. Arch Dis Child 2017;102:194-198. https://doi.org/10.1136/archdischild-2015-309584

Boyle EM, Johnson S, Manktelow B, et al. Neonatal outcomes and delivery of care for infants born late preterm or moderately preterm: a prospective population-based study. Archives of Disease in Childhood Fetal and Neonatal Edition. 2015;100(6):F479-F485. https://doi.org/10.1136/archdischild-2014-307347




DOI: http://dx.doi.org/10.15448/1980-6108.2017.1.25876

e-ISSN: 1980-6108 | ISSN-L: 1806-5562


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