475: Does delivery indication affect neonatal respiratory complications in the late preterm period?

Abstract

complications in the late preterm period? Erin Dickert, Erol Amon, Thinh Nguyen, Sara Leibovitz, Jeffrey Gavard Saint Louis University, Obstetrics, Gynecology and Women’s Health, Division of Maternal-Fetal Medicine, Saint Louis, MO, Saint Louis University, Obstetrics, Gynecology and Women’s Health, St Louis, MO, Saint Louis University, Obstetrics, Gynecology and Women’s Health, Saint Louis, MO OBJECTIVE: Determine if delivery indication in the late preterm period affects neonatal respiratory outcomes. STUDY DESIGN: We reviewed 145 mother-infant cohorts at our institution admitted January to June 2010 who subsequently delivered late preterm (34 to 36 weeks gestation). Statistical analyses were performed for 18 obstetrical variables to evaluate outcomes based on delivery indication. Deliveries were categorized as “spontaneous” if preterm labor or PROM with labor occurred. All others were classified as “indicated”. This was further divided into “hard” (non-reassuring fetal heart rate tracing, bleeding, severe pre-eclampsia and PROM with chorioamnionitis) and “soft” (oligohydramnios, PROM, and positive lung maturity) indications. RESULTS: The mean GA at admission was 34 5/7 weeks with a range of 29-36 weeks. Mean maternal age 26.2 years and 55 % were Caucasian. The most common reasons for admission were PPROM (44%) and preterm labor (26%). 52% delivered spontaneously, 27% were delivered for iatrogenic “hard” indications, and 21% with iatrogenic “soft” indications. Infants required delivery room resuscitation 25.7% of the time with an increased proportion at 34 weeks versus later gestational ages. Respiratory complications included RDS, need for respiratory intervention and surfactant use. Infants with respiratory complications were more likely to be African-American (p 0.01), require tocolysis (p 0.001), and be a younger gestational age (p 0.001). However, after controlling for gestational age, respiratory complications were not significantly different between groups based on delivery indication. A three day increase in gestational age would reduce respiratory complications by 94.4%. CONCLUSION: Respiratory complications are some of the most common complications attributed to late preterm birth. In this cohort, the indication for delivery did not predict respiratory complications. However, the data supports previous research that respiratory complications are more likely at earlier gestational ages. If possible, delaying delivery by just a few days will significantly decrease respiratory complications.