Late preterm infants in Spain: Experience of the 34–36 Neonatal Group

Abstract

Late preterm (LP) infants (34–36 weeks of gestation) are the largest group of preterm infants and also the least studied so far. In order to improve their care and reduce the impact of their increased morbidity and mortality, it is essential to know the current situation in Spain. Clinical-epidemiological variables of the LP population of 34 participating hospitals were prospectively collected from April 1, 2011 to March 31, 2016, and were then compared with the Minimum Perinatal Data Set for term births in the database. Of the 9,121 LP studied, 21.7% of 34, 30.8% of 35, and 47.5% of 36 weeks of gestation. The mortality rate was 2.8%. More than one-quarter (27.7%) were multiple pregnancies. Maternal diseases were identified in 47.1% and 41.4% were pathological gestation. Just under half (47.9%) were by Caesarean section and 18.8% were of unknown origin or unjustified. No known cause of prematurity was found in 29%, and 3.1% were recognised as unjustified. Just under half (47%) of the LP were breastfed, and 58.6% required admission to neonatology, with 15.2% to Neonatal Intensive Care Unit. Coded diagnoses were recorded in 46.2%, with the most frequent being jaundice, 43.5%, hypoglycaemia, 30%, and respiratory disorders with 28.7%. The large sample of LP studied helps us to highlight the higher neonatal mortality and morbidity that this population suffers and the unavoidable relationship of its incidence with multiparity, maternal ageing, and the still numerous inductions of labour and unjustified elective caesareans. Los prematuros tardíos (PT) (34-36 semanas de gestación) son el grupo más amplio de prematuros y menos estudiado hasta ahora. Para mejorar sus cuidados y disminuir el impacto de su mayor morbimortalidad, es primordial conocer su realidad en nuestro país. Se recogen prospectivamente variables clínico-epidemiológicas de la población de PT de 34 hospitales participantes, desde el 1 de abril del 2011 al 31 de marzo del 2016. Se comparan con las de la base de datos Conjunto Mínimo de Datos Perinatales para nacidos a término. Se estudia a 9.121 PT, el 21,7% de 34, el 30,8% de 35 y el 47,5% de 36 semanas de gestación. Falleció el 2,8‰. El 27,7% fueron embarazos múltiples, el 47,1% identificó enfermedades maternas y el 41,4% patología gestacional. Nacieron por cesárea el 47,9%, el 18,8% de origen no conocido o injustificado. En un 29% no se encontró causa conocida de prematuridad y el 3,1% se reconoció como injustificada. Lactancia materna en el 47%. El 58,6% precisó ingreso en neonatología, el 15,2% en UCIN. El 46,2% codificó algún diagnóstico, los más frecuentes: ictericia (43,5%), hipoglucemia (30%) y trastornos respiratorios (28,7%). La numerosa muestra de PT estudiada nos ayuda a poner en relieve la mayor morbimortalidad neonatal que presenta esta población y la ineludible relación de su incidencia con la multiparidad, el envejecimiento materno y las aún numerosas inducciones de parto y cesáreas electivas no justificadas.