158: The association of delivery indication with neonatal outcomes in the late preterm period

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Whether the indication for delivery in the late preterm period is associated with neonatal outcomes is poorly understood. We therefore took advantage of a large, carefully characterized cohort of women at high risk of late preterm birth to evaluate this issue. This is a secondary analysis of a multicenter, placebo controlled trial in which women with singleton pregnancies at risk for delivery at 34 0/7 - 36 5/7 weeks’ gestation were randomized to a single course of antenatal corticosteroids (betamethasone) or placebo. Women were eligible if they were in spontaneous preterm labor (PTL); had preterm prelabor rupture of membranes (PPROM); or were undergoing indicated preterm delivery (iPTD). The primary outcome was a composite of respiratory treatment within 72 hours of delivery, stillbirth, or neonatal death. Other outcomes included major respiratory morbidity; use of continuous positive airway pressure or high flow nasal cannula; a composite of respiratory distress syndrome, transient tachypnea of the newborn, and apnea; newborn intensive care unit admission; and feeding problems. Odds ratios (OR) were calculated for outcomes by indication and adjusted (aOR) for gestational age, birth weight, infant sex, delivery route, major malformations, race/ethnicity, and treatment group. There were 2,831 participants: 792 (28.0%) PTL, 620 (21.9%) PPROM, and 1,419 (50.1%) iPTD. The primary outcome occurred in 232 (16.4%) infants born after iPTD versus 58 (7.3%) infants born after PTL (aOR 1.71, 95% CI 1.21-2.43), and versus 77 (12.4%) infants born after PPROM (aOR 2.01, 95% CI 1.45 – 2.79). Compared to PTL, all neonatal complications except feeding problems occurred significantly more frequently in the iPTD group. Compared to PPROM, iPTD had significantly more neonatal complications across all measures except NICU admission. Outcomes were similar between PPROM and PTL (Table 1). Among late preterm infants, iPTD was associated with greater neonatal morbidity and respiratory complications compared with PTL or PPROM despite the administration of antenatal corticosteroids.