A Comparison of Neurodevelopmental Outcomes of Late Preterm Infants with Healthy Full-term Infants at Imam Khomeini Hospital, 2019-2020.

Every Week Matters

Indications for delivery and short-term neonatal outcomes in late preterm as compared with term births

Admission and respiratory outcomes of late preterm infants in the setting of high cesarean section deliveries: A single center retrospective analysis

Perinatal outcome of pregnancies with intrauterine passage of meconium at 37-39 compared with 40-42 weeks' gestation

We hypothesized that neonatal intensive care unit (NICU) admission reduces breastfeeding in a recent population of US infants, adjusting for confounding factors. Using pregnancy risk assessment monitoring system data from 27 states for the years 2000 to 2003, we determined the relationship between breastfeeding and gestational age (GA) stratified by NICU status. We fitted a proportional odds model for breastfeeding duration as a function of NICU status adjusted for other covariates. SAS 9.1.3 and SUDAAN 9.0 were used for the weighted analyses. In total 138 359 surveys, including 29 940 NICU-admitted infants, were analyzed. A total of 73% of mothers of nonadmitted infants initiated breastfeeding vs 70% of mothers of NICU-admitted infants. Mothers of GA <38 weeks NICU-admitted infants were 34% more likely to initiate breastfeeding and 21% more likely to breastfeed for 4 weeks than were mothers of nonadmitted preterm infants (P<0.001). However, mothers of term NICU-admitted infants were less likely to initiate and continue breastfeeding to 4 weeks than were mothers of term nonadmitted infants (P<0.001). Adjusting for GA, race, maternal age, maternal education, mode of delivery and Medicaid status, NICU admission was associated with increasing duration of breastfeeding (OR 1.10, CI 1.03, 1.17). Compared with mothers of term infants, mothers of <32-week infants were 40% more likely to continue breastfeeding for 4 weeks, mothers of 32 to 34 week infants were 13% less likely to continue and mothers of 35-37 week infants were 22% less likely to continue for at least 4 weeks (P<0.001). NICU admission is now a positive influence on breastfeeding continuation, improving the overall likelihood by 10%. Mothers of preterm NICU-admitted infants were more likely than mothers of nonadmitted infants to continue breastfeeding for 4 weeks, while mothers of term NICU-admitted infants were less likely to continue. Breastfeeding support should be enhanced for term and late preterm infants.

BackgroundRespiratory distress syndrome (RDS) is one of the leading causes of early neonatal morbidity and mortality in late preterm infants (LPIs) worldwide. This matched cohort study aimed to assess how the antenatal dexamethasone use affect the respiratory distress (RD) proportion in preterm newborns between 34 0/7 weeks and 36 6/7 weeks of gestation.MethodsThis was a prospective cohort study on 78 women with singleton pregnancy who were in threatened preterm birth and had not received prior dexamethasone, who were admitted between 34 0/7 weeks and 36 6/7 weeks at Hue University of Medicine and Pharmacy Hospital from June 2018 to May 2020. The matched control group without dexamethasone use included 78 pregnant women diagnosed with threatened late preterm births who were at similar gestational ages and estimated fetal weights as the treatment group. The treatment group received 6 mg intramuscular dexamethasone every 12 h for a total of 4 doses or until delivery. Primary outcome was the rate of neonatal RD. Secondary neonatal outcomes included the need for respiratory support, neonatal intensive care unit (NICU) admission, hypoglycemia, necrotizing enterocolitis, intraventricular hemorrhage, and neonatal death. Statistical analyses were performed by using SPSS software, version 26.0.ResultsThe proportion of RD in LPI was significantly lower in the treatment group than in the matched control group (10.3% vs. 23.1%, respectively), adjusted Odds Ratio [aOR] 0.29; 95% confidence interval [CI] 0.10 – 0.83 and p = 0.021. Neonatal hypoglycemia was more common in the dexamethasone group than in the matched group (25.6% vs. 12.8%, respectively; aOR, 2.59; 95% CI, 1.06 – 6.33; p = 0.037). There were no significant between-groups differences in the incidence of respiratory support, NICU admission or length of hospital stay.ConclusionsAdministration of antenatal dexamethasone to women at risk for late preterm birth could help to lower the proportion of respiratory distress in late preterm infants.

Prediction by maternal risk factors of neonatal intensive care admissions: Evaluation of >59,000 women in national managed care programs

40 - The Late Preterm Infant

To evaluate trends in neonatal intensive care unit (NICU) admissions, illness acuity, and hospitalization costs among U.S. children's hospitals from 2017 to 2022. This retrospective cohort study used data from the Pediatric Health Information System (PHIS) and included all NICU admissions. We examined trends in patient characteristics (e.g., gestational age, complex chronic conditions), illness severity scores, and standardized hospital costs. Interrupted time series analyses assessed changes in NICU costs over time. There were 234,571 infants admitted to NICUs in US children's hospitals between 2017 and 2022. NICU admissions shifted significantly by gestational age with admissions increasing by 10-18% among extremely, very, and late preterm infants. Term infants remained the largest admission group, averaging 45% annually (p < 0.001). Infants with ≥1 complex chronic condition increased from 46.6% in 2017 to 50.9% in 2022 (p < 0.001). NICU-specific illness severity increased modestly over time (1.14-1.24, p < 0.001). Median standardized NICU hospital costs rose by approximately 20% over the study period, with notable inflections in early 2020 and 2021. Among US children's hospitals in the PHIS database, NICU admissions were increasingly complex and costly. These findings highlight the importance of ongoing monitoring of resource use and patient mix in specialized NICU settings.

Background: Obesity is becoming an increasingly commonplace health problem. Obesity during pregnancy is important because the condition adversely affects not only the mother, but also the developing fetus and the newborn.Objective: The primary objective of this study was to evaluate the association between maternal body mass index (mBMI) at the time of delivery and neonatal intensive care unit (NICU) admission of offspring and to analyze the role of possible confounding variables that are often associated with obesity. Comorbidities, such as gestational diabetes mellitus (DM), hypertension (HT) and/or pre-eclampsia (PEC), are more common in more obese mothers, as is a higher association of obesity among non-Caucasian patients.Methods: Using a retrospective cohort design, 1736 mothers and their singleton live-born at ≥35 weeks’ gestation were analyzed for mBMI, maternal conditions of DM, HT and/or PEC, and whether NICU care was required and the reason for NICU admission.Results: NICU admission rate was significantly associated with maternal obesity. In comparing women with mBMI < 30 versus mBMI ≥ 30, OR was 1.39 (p = 0.045); OR increased to 1.76 (p = 0.006) in comparing patients with mBMI ≥ 35. mBMI was significantly associated with an increased rate of maternal DM, HT and PEC (p < 0.05 each); however, NICU admission rate was not correlated with DM, HT or PEC. The relationship between NICU admission and mBMI was significant in Caucasian mothers versus a borderline significance in African-American mothers (p = 0.035 versus p = 0.05). After controlling for neonatal hypoglycemia (NH) as the reason for admission to the NICU, no mBMI-NICU association persisted. The rate of infants with NH increased in higher mBMI groups, independent of maternal DM diagnosis.Conclusion: This study demonstrated a significant association between higher mBMI groups and NICU admissions independent of diagnosis of maternal comorbidities. However, accounting for NH eliminating this association suggests a pre-clinical diabetic pathology in obese women that affects newborn outcome. Despite increased percentage of nonwhite mothers in higher mBMI groups, African–American race does not seem to be a significant contributing factor in the increased rate of NICU admission in our population.

Identifying underlying social risk factors for neonatal intensive care unit (NICU) admission is important for designing interventions to reduce adverse outcomes. We aimed to determine whether a patient's exposure to community-level stressors as measured by the social vulnerability index (SVI) is associated with NICU admission. Retrospective cohort study (2014-2018) of patients delivering a liveborn ≥ 22 weeks' gestation at a quaternary care center. Patient addresses were used to assign each individual a composite SVI and theme score. The primary exposure was a composite SVI score categorized into tertiles. The primary outcome was NICU admission. Secondary outcomes included NICU length of stay and neonatal morbidity composite. Multivariable logistic regression was performed to estimate the association between composite SVI and outcomes (low SVI as referent). We secondarily compared mean composite and theme SVI scores; individual components of each theme were also compared. From 2014 to 2018, 13,757 patients were included; 2,837 (21%) had a neonate with NICU admission. Patients with higher SVI were more likely to self-identify as Black race and have medical comorbidities. Living in areas with moderate or high SVI was not associated with NICU admission (moderate SVI adjusted odds ratio [aOR]: 1.13, 95% confidence interval [CI]: 0.96-1.34; high SVI aOR: 1.12, 95% CI: 0.95-1.33). Moderate SVI was associated with increased neonatal morbidity (aOR: 1.18, 95% CI: 1.001-1.38). In an analysis of SVI as a continuous variable, mean SVI scores were significantly higher in individuals who had an infant admitted to the NICU. Those requiring NICU admission lived in areas with lower per capita income and a higher number of mobile homes (p < 0.001). Patients living in areas with moderate or high SVI were not shown to have higher odds of having a neonate admitted to the NICU. Neonatal morbidity was higher in those living in areas with moderate SVI. Increased access to social services may improve neonatal outcomes. · Mean SVI scores are higher in those with a neonate admitted to the NICU.. · There was no observed association between moderate and high SVI scores and NICU admission.. · Moderate SVI is associated with an increased odds of overall neonatal morbidity.. · Greater exposure to low income may be associated with NICU admission..

To compare neonatal intensive care unit (NICU) admission rates and length of stay (LOS) of late preterm infants (LPIs) born before and after opening a specialized care nursery (SCN) at our academic, pediatric tertiary care center with ∼4,500 total deliveries annually. Retrospective chart review of inborn LPIs (35(0/7)-36(6/7) weeks) who were asymptomatic or minimally symptomatic at birth and delivered 7 months before the opening of the SCN (pre-SCN) or 7 months subsequently (post-SCN). Infants were excluded for major congenital anomalies or other conditions requiring immediate NICU admission. The pre-SCN options for care were standard couplet care or NICU. The post-SCN options for care were standard couplet care, SCN, or NICU. Pre-SCN (n = 109), 73 (67%) infants received standard couplet care, while 36 (33%) infants were ever admitted/transferred to the NICU. Post-SCN (n = 112), 59 (53%) infants received standard couplet care, while 20 (18%) were ever admitted/transferred to the NICU. A total of 33 (29%) infants were admitted/transferred to the SCN and avoided a NICU stay. Median LOS for all infants was 3 days. The frequency of LPIs admitted/transferred to the NICU decreased by ∼50% after the opening of the SCN. LOS did not differ by birth cohort, but did differ significantly by location of care (standard couplet care < SCN < NICU).

Feeding Problems in the Late Preterm Infant

Most neonatal outcome studies have focused on extremely premature or very-low-birth-weight infants. Limited long-term outcome data are available for infants born at 32- to 36-week gestation. This study compared test scores, teacher evaluations, individualized education programs (IEPs), and special educational services from kindergarten (K) to fifth grade in 970 preterm infants, including moderate preterm (MP) infants born at 32- to 33-week gestation and late preterm (LP) infants born at 34 to 36 weeks, and 13,671 full-term (FT) control infants. None of those studied had had neonatal compromise that would have qualified them for developmental follow-up. In direct child assessment tests, LP infants scored lower than FT infants in reading but not in math in K and first grade. For teacher academic rating scale scores, LP infants in multiple grades scored lower than FT infants for both reading and math. LP infants also had a greater need than those in the FT group for individualized education programs and special education services. MP infants scored lower for reading in K and grades 1 and 5 and lower for math at all grade levels. For teacher academic rating scale scores, MP infants in all post-K grades had worse reading and math skills than LP or FT infants. Compared with FT infants, twice as many MP infants required special education at all grade levels. After adjusting for gender, race, and maternal educational level, LP infants in the first grade were substantially likelier to have below-average scores in both reading and math than FT infants. MP infants had a similar adjusted risk for below average reading and math test scores compared to FT infants. The risk of poor school outcomes remained significant when only singleton LP infants were analyzed. These findings demonstrate that infants born at 32- to 36-week gestation are more likely than full-term infants to have poor school outcomes when evaluated from kindergarten to grade 5. All preterm infants are at risk and would benefit from follow-up, anticipatory guidance, and appropriate intervention.

Neonatal intensive care unit admission is associated with lower breastfeeding in late preterm infants