Abstract
Background: There is a paucity of evidence regarding long-term outcomes of late preterm (34-36 weeks) and early term (37-38 weeks) delivery. The objective of this systematic review was to assess long-term cognitive outcomes of children born at these gestations. Methods: Four electronic databases (Medline, Embase, clinicaltrials.gov and PsycINFO) were searched. Last search was 5 th August 2016. Studies were included if they reported gestational age, IQ measure and the ages assessed. The protocol was registered with the International prospective register of systematic reviews (PROSPERO Record CRD42015015472). Two independent reviewers assessed the studies. Data were abstracted and critical appraisal performed of eligible papers. Results: Of 11,905 potential articles, seven studies reporting on 41,344 children were included. For early term births, four studies (n = 35,711) consistently showed an increase in cognitive scores for infants born at full term (39-41 weeks) compared to those born at early term (37-38 weeks) with increases for each week of term (difference between 37 and 40 weeks of around 3 IQ points), despite differences in age of testing and method of IQ/cognitive testing. Four studies (n = 5644) reporting childhood cognitive outcomes of late preterm births (34 - 36 weeks) also differed in study design (cohort and case control); age of testing; and method of IQ testing, and found no differences in outcomes between late preterm and term births, although risk of bias was high in included studies. Conclusion: Children born at 39-41 weeks have higher cognitive outcome scores compared to those born at early term (37-38 weeks). This should be considered when discussing timing of delivery. For children born late preterm, the data is scarce and when compared to full term (37-42 weeks) did not show any difference in IQ scores.
Highlights
Preterm birth rates are rising with 10% of neonates born less than 37 weeks gestation1
It is for this reason that both the Royal College of Obstetricians and Gynaecologists UK (RCOG)7 and the American college of Obstetricians and Gynecologists (ACOG)8 endorse the policy of elective birth after 39 weeks in order to reduce the risk of adverse outcome in infants born before full term (39–40 weeks gestation)
After exclusions, six studies and one conference abstract, reporting on 41,344 children/ adolescents, were included in the review; four studies comparing the outcomes within term (37–42 weeks) and three studies comparing the outcomes of late preterm delivery (34–36 weeks) with term delivery
Summary
Preterm birth rates are rising with 10% of neonates born less than 37 weeks gestation. Term delivery is associated with increased short term adverse physical morbidity, including respiratory distress syndrome, transient tachypnoea of the neonate and ventilator use, as well as an increased risk of infant mortality at 37 weeks compared to full-term delivery. Term delivery is associated with increased short term adverse physical morbidity, including respiratory distress syndrome, transient tachypnoea of the neonate and ventilator use, as well as an increased risk of infant mortality at 37 weeks compared to full-term delivery4–6 It is for this reason that both the Royal College of Obstetricians and Gynaecologists UK (RCOG) and the American college of Obstetricians and Gynecologists (ACOG) endorse the policy of elective birth after 39 weeks in order to reduce the risk of adverse outcome in infants born before full term (39–40 weeks gestation). For children born late preterm, the data is scarce and when compared to full term (37-42 weeks) did not show any difference in IQ scores
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