Abstract
BackgroundElective delivery prior to term gestation is associated with adverse neonatal outcomes. The impact of American College of Obstetricians and Gynecologists (ACOG) guidelines recommending against induction of labor (IOL) < 39 weeks’ postmenstrual age (PMA) on the frequency of early-term births and NICU admissions in Erie County, NY was evaluated in this study.MethodsThis is a population-based retrospective comparison of all live births and NICU admissions in Erie County, NY between pre-and post-ACOG IOL guideline epochs (2005–2008 vs. 2011–2014). Information on early-term, full/late/post-term births and NICU admissions was obtained. A detailed chart analysis of indications for admission to the Regional Perinatal Center was performed.ResultsDuring the 2005–2008 epoch, early-term births constituted 27% (11,968/44,617) of live births. The NICU admission rate was higher for early-term births (1134/11968 = 9.5%) compared to full/late/post-term (1493/27541 = 5.4%).In the 2011–2014 epoch, early-term births decreased to 23% (10,286/44,575) of live births. However, NICU admissions for early-term (1072/10286 = 10.4%) and full/late/post-term births (1892/29508 = 6.4%) did not decrease partly due to asymptomatic infants exposed to maternal chorioamnionitis admitted for empiric antibiotic therapy as per revised early-onset sepsis guidelines.ConclusionsACOG recommendations against elective IOL or cesarean delivery < 39 weeks PMA were rapidly translated to clinical practice and decreased early-term births in Erie County, NY. This decrease did not translate to reduced NICU admissions partly due to increased NICU admissions for empiric antibiotic therapy.
Highlights
Elective delivery prior to term gestation is associated with adverse neonatal outcomes
Research has convincingly demonstrated that neonatal outcomes improve with increasing gestational age, with the best outcomes seen in infants delivered at 39–40 weeks post-menstrual age (PMA) [1, 2]
Our current study focuses on the impact of the 2009 ACOG guidelines on early-term births and neonatal intensive care unit (NICU) admissions in Erie County, NY
Summary
Elective delivery prior to term gestation is associated with adverse neonatal outcomes. The impact of American College of Obstetricians and Gynecologists (ACOG) guidelines recommending against induction of labor (IOL) < 39 weeks’ postmenstrual age (PMA) on the frequency of early-term births and NICU admissions in Erie County, NY was evaluated in this study. The American College of Obstetricians and Gynecologists (ACOG) has restricted elective term delivery to women with a confirmed gestational age of at least 39 weeks for the past two decades. In spite of these recommendations, elective deliveries at less than 39 weeks PMA were not. Our current study focuses on the impact of the 2009 ACOG guidelines on early-term births and neonatal intensive care unit (NICU) admissions in Erie County, NY. We investigated the effect of revised earlyonset sepsis management guidelines from 2010 on NICU admissions [7, 8]
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