Early Term Infants Research Articles

Comparative Study of the Safety and Efficacy of Intramuscular Dexamethasone, Betamethasone Phosphate, and Standard Management Protocol in Early-Term Scheduled Caesarean Delivery.

Background Babies born between 37 weeks +0 days and 38 weeks +6 days by scheduled caesarean delivery before the onset of labour are more prone to developing respiratory complications than babies delivered between 39 weeks +0 days and 40 weeks +0 days. Antenatal corticosteroids have been used in preterm births for lung maturity. The advantages of administering antenatal corticosteroids before a scheduled caesarean delivery in the early term remain a subject of debate. While some studies have reported benefits, including a reduction in respiratory issues, the evidence is still inconclusive. The study's main objective is to compare the efficacy and safety of intramuscular dexamethasone and betamethasone phosphate with standard treatment protocols in early-term infants. Methodology A total of 241 pregnant women scheduled for caesarean delivery were screened for eligibility to participate in the study. Out of these, 192 women met the inclusion criteria and were enrolled in the study after providing written informed consent; they were randomised into three groups, with 64 in each group, and were given either betamethasone phosphate or dexamethasone intramuscularly or were considered under standard management protocol (no administration of corticosteroids). The primary comparison was done to observe the development of respiratory distress syndrome, transient tachypnoea in newborns, and the need for neonatal intensive care unit (NICU) admission. Results Among 192 pregnant females observed, the incidence of development of respiratory distress syndrome did not differ significantly between the betamethasone, dexamethasone, and standard management groups, with rates of 6.25%, 7.81%, and 4.7%, respectively.Additionally, out of the 192 infants, 15 required neonatal intensive care, including 6 (9.4%) from the betamethasone group, 5 (7.8%) from the dexamethasone group, and 4 (6.3%) from the standard management group. All of these infants had a maximum stay of four days in the NICU, did not require mechanical support, and improved with oxygen therapy. Conclusion In our study, in early-term gestation, both the corticosteroid groups showed similar effects to those of the standard management group in reducing neonatal morbidity, with no significant statistical difference. Hence, the choice lies with the treating obstetrician to consider the administration of corticosteroids in early-term caesarean deliveries.

Effect of gestational age on cerebral lesions in neonatal encephalopathy

ObjectiveTo determine the risk on brain lesions according to gestational age (GA) in neonates with neonatal encephalopathy.DesignSecondary analysis of the prospective national French population-based cohort, Long-Term Outcome of NeonataL EncePhALopathy.SettingFrench...

Donor human milk versus infant formula for low-risk infants: a systematic review.

There is an increasing acceptance and use of donor human milk (DHM) in healthy infants. This review investigates the benefits and risks of mothers' own milk (MOM) supplementation with DHM compared to infant formula (IF) in moderate-late preterm (MLP) and early term (ET) infants. MEDLINE, EMBASE, CINAHL, Scopus, Cochrane CENTRAL and clinical trial registries were searched for studies published up to September 2023. The primary outcome was rates of exclusive breastfeeding (EBF). Certainty of evidence was assessed using GRADE framework. RoB1 and EPHPP were used to assess risk of bias for controlled trials and observational studies, respectively. Eleven studies involving total of 10,147 infants and six ongoing trials were identified. Studies were of low quality, and the certainty of evidence was assessed as very low. Three studies suggested benefits of DHM compared to IF on EBF at discharge, while two suggested no difference. No clear effect was observed on EBF duration, any breastfeeding, hypoglycemia and morbidity. No health risks were reported. The effect of supplementing MOM with DHM instead of IF on EBF and other health outcomes is unclear. High-quality studies are required to determine the potential benefits or risks of DHM supplementation in this population. We identified 11 relevant studies reporting on supplementation of mothers' own milk (MOM) with donor human milk (DHM) compared to infant formula (IF). Studies were of low quality, had heterogeneous outcome definitions and were geographically limited; all except two were observational studies. Limited evidence showed no clear difference on rates of exclusive breastfeeding and other health outcomes. No potential risks were reported. The increasing acceptance and use of DHM in healthy infants highlights the need for future high-quality studies.

Gestational Age and Neurodevelopmental Delay in Term Births at 6 and 12 Months: The Japan Environment and Children’s Study (JECS)

BackgroundIn the recent years, a high risk of developmental delay not only in very low birth weight infants and late preterm infants but also in early term infants (37–38 weeks) have increasingly been reported. However, in Japan, there are virtually no studies regarding the development delays in early term infants.MethodsThis study used the data from the Japan Environment and Children’s Study (JECS), a birth cohort study conducted in Japan. Data were selected for analysis from the records of 104,065 fetal records. The risk of neurodevelopmental delays at 6 months and 12 months after birth was evaluated using multivariate analysis for infants of various gestational ages, using the 40th week of pregnancy as a reference value. Neurodevelopment was evaluated at 6 months and 12 months after birth using the Ages and Stages Questionnaires, Japanese translation (J-ASQ-3).ResultsThe proportion of infants born at a gestational age of 37 to 38 weeks who did not reach the J-ASQ-3 score cutoff value was significantly higher in all areas at both 6 months and 12 months after birth, when compared to that of infants born at 40 weeks. The odds ratio decreased at 12 months after birth compared to that at 6 months after birth.ConclusionEarly term infants in Japan are at an increased risk of neurodevelopmental delay at 12 months after birth.

Are Maternal Vitamin D (25(OH)D) Levels a Predisposing Risk Factor for Neonatal Growth? A Cross-Sectional Study.

Neonatal bone mass may potentially be influenced by existing maternal vitamin D (25(OH)D) levels. Few studies evaluated maternal vitamin D deficiency (VDD) with neonatal anthropometrics such as weight, height and head circumference (HC), especially in Greece, which is a Mediterranean country with plenty of sunshine and consequently benefits the synthesis of 25(OH)D. We investigated this potential association in Greece, taking into account the administration or not of prenatal vitamin D supplements. The purpose of our study is to ascertain if there is a possible association between maternal VDD and neonatal specific anthropometric characteristics (weight, height and HC) at birth. If this is confirmed by future clinical studies, it would be of interest to develop a prenatal pregnancy selection program that would detect VDD early or during pregnancy in order to improve fetal-neonatal development in a Mediterranean country like ours. We performed a cross-sectional study on 248 early early term infants (after 37 + 0 to 38 + 6 weeks of gestation) but also on full-term infants (after 39 to 40 weeks of gestation) and their Greek mothers from September 2019 to January 2022. Blood samples of 25(OH)D were taken from the mother at the beginning of labor and cord blood was taken from the newborn. Pregnant women were divided into two groups: those who received or did not receive a normal dose of calcium (500 mg/day) and vitamin D supplements (400-800 IU/day) as instructed by their treating physicians. Our findings revealed a positive association between maternal VDD and low neonate birth weight (LBW) in women receiving vitamin D during pregnancy and no association between maternal VDD and neonatal height or head circumference (HC) at birth. Overall, this study highlighted the association between maternal VDD at the end of gestation and LBW neonates born to mothers who received vitamin D supplementation. We did not find any correlation in two of the three somatometric characteristics studied, height and HC. In any case, more clinical studies are needed to further corroborate any potential association of maternal VDD with other neonatal somatometric characteristics.

Short-term outcomes in early term infants (born at 37 or 38 weeks): a retrospective investigation.

Recently, researchers have introduced the concept of 'early term' infants, defined as infants born at 37 or 38 weeks of gestation, and their outcome has been discussed. Although the complications experienced by early term are less severe than those in preterm infants, this group accounts for a much larger proportion of newborns, making the assessment of outcomes important in clinical practice. This observational study of term infants born at Tokyo Metropolitan Toshima Hospital aimed to understand the short-term outcomes in early term infants. Data extracted from the medical records were analyzed. Among 4,669 eligible participants, 463 (9.9%) were born at 37 weeks and 1,270 (27.2%) were born at 38 weeks. The remaining 2,936 infants were born after 39 weeks of gestation. Logistic regression analysis showed higher odds ratio of hospitalization (1.56, 95% CI: 1.37-1.79, p < 0.05), apnea (2.23, 95%CI: 1.08-4.60, p < 0.05), and hypoglycemia (3.13, 95%CI: 1.95-5.03, p < 0.05) in early term infants. In detail, infants born at 37 weeks of gestational age had higher odds ratio for hospitalization (2.07, 95%CI: 1.68-2.35, p < 0.05) and hypoglycemia (4.11, 95%CI 2.22-7.60, p < 0.05) than infants born at 38 weeks of gestational age (1.40, 95%CI: 1.20-1.62, p < 0.05, and 2.78, 95%CI: 1.66-4.67, p < 0.0 respectively). This study revealed complicated clinical course in early term infants, and represents one of the largest contributions to understanding the outcomes of early term infants, and could help to determine strategies for elective cesarean section. According to this result, elective cesarean sections would be better planned at 38 weeks of gestational age. Moreover, in clinical practice, it is important to be aware of the complicated clinical course in early term infants.

Respiratory morbidity and short-term outcome in moderate preterm, late preterm, and early-term infants at a tertiary care hospital in Southern India

ABSTRACT Introduction: Moderate and late preterm and early-term infants constitute a significant proportion of hospitalizations in neonatal intensive care units (NICU), yet have been perceived as low-risk groups. Their gestational age-specific data have been poorly studied, including respiratory morbidity and outcome. Objectives: The objectives of this study were to determine the respiratory morbidity among moderate and late preterm and early-term infants and to study their short-term outcomes. Materials and Methods: A longitudinal descriptive hospital-based study was conducted at a tertiary care hospital in Southern India, from January 2018 to June 2019. Newborns between 32 and &lt;39 completed weeks, after gestational age assessment, were observed until discharge and later followed up to 40 weeks of gestation. The outcome was recorded in terms of respiratory issues, length of hospital stay, and readmissions within a month. Results: Two hundred and fifty babies were included in the study. NICU care was required in 78%, 72%, and 9.2% of moderate preterm, late preterm, and early-term infants, respectively. Respiratory distress was noted in 78%, 66%, and 6% of moderate preterm, late preterm, and early-term infants, respectively. The association of respiratory distress with gestational age was highly significant (P &lt; 0.0001). Surfactant requirement was 12%, 6%, and 1.7% among the three groups. The average length of NICU stay was 7.8 days, 6.5 days, and 0.3 days among moderate and late preterms and early-term infants, respectively. Conclusion: Moderate and late preterms and early-term infants have significant morbidities. Gestational age has a substantial correlation with respiratory distress and neonatal outcomes. Knowledge about these issues can ensure improved outcome in these infants.

Weekly prenatal PM2.5 and NO2 exposures in preterm, early term, and full term infants: Decrements in birth weight and critical windows of susceptibility

BackgroundPrevious studies have observed associations between birth weight and prenatal air pollution exposure, but there is not consensus on timing of critical windows of susceptibility. ObjectiveWe estimated the difference in birth weight among preterm, early term and full term births associated with weekly exposure to PM2.5 and NO2 throughout gestation. MethodsWe included all singleton live births in the Lower Peninsula of Michigan (United States) between 2007 and 2012 occurring at or after 32 weeks gestational age (n = 497,897). Weekly ambient PM2.5 and NO2 concentrations were estimated at maternal residences using 1-km gridded data from ensemble-based models. We utilized a distributed lag nonlinear model to estimate the difference in birth weight associated with weekly exposures from the last menstrual period (week 0) through 31 weeks gestation for preterm births; through 36 weeks gestation for early term births; and through 38 weeks gestation for full term births. ResultsIn single-pollutant models, a 5 μg/m3 increase in PM2.5 exposure was associated with a reduction in birth weight among preterm births (−37.1 g [95% confidence interval [CI]: 60.8 g, −13.5 g]); early term births (−13.5 g [95% CI: 26.2 g, −0.67 g]); and full term births (−8.23 g [95% CI: 15.8 g, −0.68 g])]. In single-pollutant models, a 10 ppb increase in NO2 exposure was associated with a −11.7 g (95% CI: 14.46 g, −8.92 g) decrement in birth weight among full term births only. In models co-adjusted for PM2.5 and NO2, PM2.5 exposure was associated with reduced birth weight among preterm births (−36.9 g [95% CI: 61.9 g, −11.8 g]) and NO2 exposure was associated with reduced birth weight among full term births (−11.8 g [95% CI: 14.7 g, −8.94 g]). The largest decrements in birth weight were associated with PM2.5 exposure between approximately 10 and 26 weeks of pregnancy; for NO2 exposure, the largest decrements in birth weight in full term births were associated with exposure between weeks 6–18. ConclusionWe observed the largest and most persistent adverse associations between PM2.5 exposure and birth weight in preterm infants, and between NO2 exposure and birth weight in full term infants. Exposure during the first half of pregnancy had a greater impact on birthweight.

Maternal capital predicts investment in infant growth and development through lactation.

Maternal capital (MC) is a broad term from evolutionary biology, referring to any aspects of maternal phenotype that represent resources available for investment in offspring. We investigated MC in breastfeeding mothers of late preterm and early term infants, examining its relationship with infant and breastfeeding outcomes. We also determined whether MC modified the effect of the relaxation intervention on these outcomes. The data was collected as part of a randomized controlled trial investigating breastfeeding relaxation in 72 mothers of late preterm and early term infants. Indicators of MC (socioeconomic, social, somatic, reproductive, psychological, and cognitive) were collected at baseline at 2-3 weeks post-delivery. Principal Component Analysis was conducted for the MC measures and two components were identified: 1."Subjective" maternal capital which included stress and depression scores, and 2."Objective" maternal capital which included height, infant birth weight, and verbal memory. Univariate linear regression was conducted to assess the relationship between objective and subjective MC (predictors) and infant growth, infant behavior, maternal behavior, and infant feeding variables (outcomes) at 6-8 weeks. The interaction of MC and intervention assignment with outcomes was assessed. Higher objective MC was significantly associated with higher infant weight (0.43; 95%CI 0.21,0.66) and length z-scores (0.47; 95%CI 0.19,0.76), shorter duration of crying (-17.5; 95%CI -33.2,-1.9), and lower food (-0.28; 95%CI -0.48,-0.08) and satiety responsiveness (-0.17; 95%CI -0.31,-0.02) at 6-8 weeks. It was also associated with greater maternal responsiveness to infant cues (-0.05, 95%CI -0.09,-0.02 for non-responsiveness). Greater subjective maternal capital was significantly associated with higher breastfeeding frequency (2.3; 95%CI 0.8,3.8) and infant appetite (0.30; 95%CI 0.07,0.54). There was a significant interaction between the intervention assignment and objective MC for infant length, with trends for infant weight and crying, which indicated that the intervention had greater effects among mothers with lower capital. Higher MC was associated with better infant growth and shorter crying duration. This was possibly mediated through more frequent breastfeeding and prompt responsiveness to infant cues, reflecting greater maternal investment. The findings also suggest that a relaxation intervention was most effective among those with low MC, suggesting some reduction in social inequalities in health.

Prolonged Oral Motor Stimulation Treatment was Effective for Breastfeeding Achievement in Full Term Infants With Feeding Problems

Objectives: Feeding problems can occur in early-term infants born at 37 weeks. Early-term and full-term infants may benefit from oral motor therapy to attain successful breastfeeding. The present study aims to determine the impact of the 5-minute premature infant oral motor intervention (PIOMI) and the 15-minute oral stimulation program (15-minute oral stimulation program) on 37 to 41 weeks infants in attaining successful breastfeeding. Methods: This clinical trial was conducted on early-term and full-term infants in the neonatal intensive care units (NICUs) of two hospitals in Mashhad City, Iran. They were randomly divided into two intervention groups (5-minute PIOMI or 15-minute oral stimulation program) and one control group (17 infants in each group). These three groups were then compared to each other after the intervention by pediatricians and speech and language specialists regarding their breastfeeding. All statistical analysis was performed using R software, version 4.0.2, and the significance level was set at 0.05. Results: Infants in both intervention groups attained different levels of breastfeeding compared to pre-intervention. This outcome could be due to our interventions or natural growth and development (P&lt;0.05). However, the longer the infants’ oral motor therapy time was, the more likely they were to breastfeed successfully. The 15-minute oral stimulation program group had a significantly higher number of male infants attaining breastfeeding after treatment than the control and PIOMI groups (P=0.03). Discussion: The PIOMI has been confirmed as an effective early intervention for small preterm infants as young as 29 weeks, and the short 5-minute therapy time is accepted in the preterm infant population. The program affects the brain’s plasticity and improves neurosensory and motor skill development for feeding. The current study indicates that PIOMI remains effective versus the control group in the full-term babies. However, the longer 15-minute oral stimulation program, is more effective in full-term infants. This finding shows that full-term infants can endure and benefit from longer than 5 minutes per day of oral motor therapy.

Retrospective analysis of 102 neonatal cases hospitalized with diagnosis of the ongoing phenomenon of neonatal period: hypernatremic dehydration

Aim: The aim of this study was to examine the prevalence of hypernatremic dehydration (HD) among term neonates admitted to a tertiary care unit over a three-year period and to identify mother and neonate related risk factors associated with HD.&#x0D; Material and Method: Medical records of 102 term babies and their mothers were analyzed retrospectively. The gender, weight at birth, type of birth, postnatal day of diagnosis, weight and weight loss percentage at diagnosis, season and presenting complaint upon admission, feeding with human milk/formula/mixed, laboratory findings, usage of antibiotics as well as maternal age, parity, residence, level of education and presence of smoking were recorded. Serum sodium (Na) levels, severity of dehydration, age on admission, and length of stay in the neonatal intensive care unit (NICU) were recorded along with any significant effect of maternal demographic properties, residence, season, gender, and type of birth.&#x0D; Results: The average Na levels were found to be 152.1±4.2 mEq/L (max:166 mEq/L). Mild, moderate and severe hypernatremia were found in 34 (33%), 62 (61%) and 6 (6%) patients, respectively. More weight loss was observed in neonates born via cesarean section vs. vaginal delivery (12.8±3.0% vs. 11.6±3.5%, p=0.01). Higher serum Na levels (153.9±4.86 mEq/L vs. 151±2.34 mEq/L, p=0.008) and a greater median age at admission (4.5 [IQR4-6]) days vs. 3 [IQR3-4]) days, p=0.03) were reported for neonates born to mothers residing in rural/suburban vs. urban areas. Serum Na levels were not different based on the mother's level of education or parity (p=0.96 and p=0.29, respectively). There was no difference in serum Na levels (p=0.05) but the percentage of weight loss was higher when the mother smoked (14.3±3.8% vs. 11.7±3.1%, p=0.003). Serum Na and glucose levels were lower, antibiotics usage rates, and prevalence of mixed feedings were higher in early term infants (p=0.01, p=0.002, p=0.04 and p=0.04, respectively). Males had higher creatinine levels (0.89±0.27 mg/dl vs. 0.78±0.28 mg/dl, p=0.005), but there was no difference between the sexes in terms of day of admission, percentage of weight loss, or length of stay in NICU.&#x0D; Conclusion: Hypernatremic dehydration is a significant and increasingly prevalent problem of neonatal period. Serum Na levels and severity of dehydration in neonates may be affected by the type of birth, mother's smoking status, residence and early term birth. Counseling on breastfeeding, education of health professionals and caregivers on the signs and symptoms of dehydration, and monitoring of body weight are essential for the prevention, diagnosis, and treatment of HD.

Exclusive breastfeeding: Relation to gestational age, birth weight, and early neonatal ward admission. A nationwide cohort study of children born after 35 weeks of gestation.

Prematurity, being small for gestational age and early neonatal ward admission are the major neonatal conditions that may interfere with breastfeeding supportive practices in infants born at gestational age ≥35+0 weeks. We aimed to investigate the associations between gestational age, small for gestational age, early neonatal ward admission and exclusive breastfeeding at one and four months. A register-based cohort-study of all Danish singletons with gestational age ≥35+0 weeks born in 2014-2015. In Denmark, health visitors routinely conduct free home visits throughout infants' first year and thereby report breastfeeding data to The Danish National Child Health Register. These data were linked with data from other national registers. Logistic regression models estimated the odds ratio for exclusive breastfeeding at one and four months, adjusted for confounding variables. The study population comprised 106,670 infants. Compared to gestational age 40 weeks, the adjusted odds ratio for exclusive breastfeeding at one month showed a decreasing tendency from gestational age ≥42 (n = 2,282) (1.07; 95% confidence interval (CI) 0.97-1.17) to 36 weeks (n = 2,062) (0.80; 95% CI 0.73-0.88). Small for gestational age (n = 2,342) was associated with decreased adjusted odds ratio for exclusive breastfeeding at one month (0.84; 95% CI 0.77-0.92). Neonatal ward admission was associated with increased adjusted odds ratio for exclusive breastfeeding at one month among late preterm infants (gestational age 35-36 weeks; n = 3,139) (1.31; 95% CI 1.12-1.54), as opposed to among early term (gestational age 37-38 weeks; n = 19,171) (0.84; 95% CI 0.77-0.92) and term infants (gestational age >38 weeks; n = 84,360) (0.89; 95% CI 0.83-0.94). The associations seemed to persist at four months. Decreasing gestational age and small for gestational age were associated with decreased exclusive breastfeeding rates. Neonatal ward admission was associated with increased exclusive breastfeeding rates among late preterm infants, whereas the opposite was observed among early term and term infants.

Determinants of infant behavior and growth in breastfed late preterm and early term infants: a secondary data analysis.

Late preterm and early term infants are at increased risk of poor growth, behavioral problems, and developmental delays. This study aimed to investigate the impact of maternal and infant characteristics, feeding practices, and breastmilk composition on infant behavior following late preterm and early term delivery, and toevaluate the association between infant behavior and growth. Data from 52 Chinese mothers and their late preterm/early term infants participating in the Breastfeed a Better Youngster study were used. Maternal and infant characteristics were collected using questionnaires at 1week postpartum. Breastmilk macronutrient content was measured using a human milk analyzer, and infant behavior was assessed using a 3-day infant behavior diary at 8weeks postpartum. Feeding practices were collected at both time points using questionnaires. Multivariate models were used to assess associations between potential predictors and infant behavior and between infant behavior and growth. Exclusive breastfeeding was associated with greater sleep duration (P = 0.02) and shorter crying duration (P = 0.01). Mothers with a vocational education reported greater distress duration (P = 0.006). Greater colic duration was associated with higher maternal annual income (P = 0.004). There was no significant association between infant behavior and growth (all P > 0.05). Exclusive breastfeeding might promote more favorable infant behaviors in late preterm/early term infants, while the development of infant distress behaviors was associated with some maternal characteristics (maternal education and annual income). However, due to the limitations of diary methods, determinants of infant behavior should ideally be assessed using more objective measures in larger samples.

Patent Ductus Venosus in an early term infant with mild respiratory distress – Case report

Patent ductus venosus is an extremely rare form of congenital portosystemic shunt that results in the diversion of portal blood into the systemic circulation, decreasing hepatic blood flow and increasing blood volume and toxic substances in the systemic circulation. We present a clinical case of a male infant born at 37 5/7 weeks gestational age with patent ductus venosus. Because very few cases of patent ductus venosus have been reported, the prudent approach it would be to perform serial Doppler studies and laboratory tests to follow the course of the ductus venosus until closure and to intervene if the infant becomes unstable and symptomatic. The medical team decided that the conservative management in this case was a better choice, since the infant remained stable with good growth.

Neonatal outcomes and long-term neurodevelopmental evaluations of hospitalized early term infants: prospective case-control study.

It was intended to compare early term babies to term babies by reviewing short-term issues and long-term neurodevelopmental evaluations. It was planned as a prospective case-control study. Of the 4263 infants admitted to the neonatal intensive care unit, 109 infants born at early term by elective cesarean section and hospitalized within the first 10 postnatal days were included in the study. As the control group, 109 babies born at term were enrolled. Nutrition status of infants, reasons for hospitalization in the first postnatal week were recorded. When the babies were 18-24 months old, an appointment was made for neurodevelopmental evaluation. In the early term group, the time of breastfeeding was later than the control group, with a statistically significant difference. Similarly, breastfeeding difficulty, need for formula in the first week postpartum and hospitalization were found to be significantly higher in the early term group. Considering the short-term results; pathological weight loss, hyperbilirubinemia requiring phototherapy and feeding difficulties were statistically significantly higher in the early term group. Neurodevelopmental delay did not statistically differ across the groups, but the early term group's MDI and PDI scores were found to be statistically lower than those of the term group. Early term infants are thought to be like term infants in many ways. Although these babies are similar to term babies, they are still physiologically immature. The short and long-term negative consequences of early term birth are obvious, non-medical elective early term births should be prevented.

Clinical characteristics of meconium aspiration syndrome in neonates with different gestational ages and the risk factors for neurological injury and death: A 9-year cohort study.

The presence of meconium is associated with gestational age, and the incidence of meconium aspiration syndrome (MAS) increases with gestational age. Our study compared the differences in the clinical characteristics of patients with MAS at different gestational ages and discussed the risk factors for neurological injury and death from MAS. A total of 294 neonates diagnosed with MAS between 2013 and 2021 were included. Patients were divided into preterm, early-term, full-term, and late-term groups according to gestational age. We compared the patients' basic demographic, treatment, complications, and clinical outcomes in the different groups. We also analyzed the risk factors of neurological injury and death in patients with MAS. The mean age at admission (0.55 ± 0.9 h) was lower and the proportion of cesarean deliveries (90.00%, 27/30) was higher in the preterm group than in the other three groups. There was no statistically significant difference among the four groups regarding 1- and 5-min Apgar scores and the need for delivery room resuscitation. In terms of complications, early-term infants had the highest incidence of neurological injury (52.9%, 27/51), and late-term infants had the highest incidence of pneumothorax (37.8%, 17/45). The overall mortality rate of children with MAS was 7.80% (23/294), and the difference in mortality rates among the four groups was not significant. Low 1-min Apgar score and gestational age, metabolic acidosis, and respiratory failure were independent risk factors for neurological injury; metabolic acidosis, respiratory failure, and sepsis were independent risk factors for death in neonates with MAS. The clinical characteristics of MAS neonates of different gestational age are different mainly in complications. Early-term infants are more likely to complicate with neurological injury, and late-term infants are more likely to complicate with pneumothorax. Low 1-min Apgar score and gestational age, metabolic acidosis, and respiratory failure were established as risk factors for neurological injury; metabolic acidosis, respiratory failure, and sepsis were independent risk factors for death in neonates with MAS.

Breastfeeding Duration and Exclusivity Among Early-Term and Full-Term Infants: A Cohort Study

BackgroundAs compared to full-term infants (39–41 weeks of gestation), early-term infants (37–38 wk) are at increased risk of adverse outcomes, including shorter exclusive breastfeeding (EB) duration and continued breastfeeding. ObjectivesTo compare early-term with full- and late-term infants regarding the prevalence of EB at 3 mo and any breastfeeding at 12 mo. MethodsData sets from two population-based birth cohorts conducted in the city of Pelotas, Brazil, were combined. Only term infants (37 0/7 through 41 6/7 weeks of gestation) were included in the analyses. Early-term infants (37 0/7 through 38 6/7 wk) were compared to the remaining term infants (39 0/7 through 41 6/7 wk). Information on breastfeeding was gathered through maternal interviews at the 3-mo and 12-mo follow-ups. The prevalence of EB at 3 mo and any breastfeeding at 12 mo with 95% CIs were calculated. Crude and adjusted prevalence ratios (PRs) were obtained through Poisson regression. ResultsA total of 6395 infants with information on gestational age and EB at 3 mo and 6401 infants with information on gestational age and any breastfeeding at 12 mo were analyzed. There was no difference between early-term infants and the remaining term infants regarding the prevalence of EB at 3 mo (29.2% and 27.9%, respectively) (P = 0.248). Prevalence of any breastfeeding at 12 mo was lower in early-term infants than among those born between 39 0/7 and 41 6/7 weeks of gestation (38.2% compared with 42.4%) (P = 0.001). In the adjusted analysis, the PR for any breastfeeding at 12 mo was 15% lower in the early-term group than in the remaining term infants (PR = 0.85; 95% CI: 0.76–0.95) (P = 0.004). ConclusionsThe prevalence of EB at 3 mo was similar among term infants. Nonetheless, in comparison with the remaining infants born at term, early-term infants were at increased risk of having been weaned before reaching 12 mo of age. Curr Dev Nutr 2023;xx:xx.

Risk Factors and Morbidity in Late-preterm Infants: A Comparison with Early-term and Full-term Infants

Risk Factors and Morbidity in Late-preterm Infants: A Comparison with Early-term and Full-term Infants

Revisiting the use of antenatal corticosteroids for late preterm and early term infants: An observational analytical study

Background: Guidelines from prominent policymakers on the use of antenatal steroids (ANS) in “late preterm deliveries and early term casearian deliveries” (LET) are nonuniform. This descriptive study compared LET infants born during two-time epochs: Retrospective: ANS exposed (ANSE) (when institute practice was to administer ANS to all LET mothers), and prospective – ANS unexposed (ANSU) (after the policy was revised in May 2021). Methodology: All antenatal mothers of anticipated late-preterm and early-term cesarean deliveries were being administered ANS before May 2021. Following the revision of hospital policy, this practice was discontinued. Comparative analysis for respiratory morbidity (RM) and other clinically relevant outcomes were conducted in infants born during two-time epochs (ANSE vs. ANSU) Results: Among 379 included infants, those with RMs were comparable between groups: 33 (17.5%) in ANSE; 31 (16.4%) in ANSU – Odds ratio (OR) 1.08; 95% confidence interval (CI) (0.61–1.92), P = 0.78. No difference was noted in hypoglycemia events: 23 (12.2%) in ANSE; 22 (11.6%) in ANSU, OR = 1.05 95% CI (0.56–1.96), P = 0.87. Conclusion: ANS in LET did not seem to reduce the risk of RM. It may be appropriate to audit individual unit practices and relevant outcomes before blanket recommendations are made.

Influence of daytime versus nighttime births on late preterm infant outcomes

To determine whether delivery time of day is associated with differences in neonatal management or outcome in late preterm infants. Previous investigations of neonatal morbidity based on delivery time of day have focused on infants at term and early preterm gestational ages. This is a secondary analysis of ALPS, a multicenter trial of patients with anticipated late preterm delivery (34w0d-36w6d) randomized to betamethasone or placebo. Patients were assigned to a daytime (0700-1859) or nighttime cohort (1900-0659) using the documented time of birth. Study group characteristics were compared using chi-squared test for categorical data and Wilcoxon test for continuous data. Logistic regression models were used to adjust for birth weight, mode of delivery, and ALPS group assignment. The primary outcome was the administration of respiratory resuscitation in the first 30 minutes of life. Characteristics of the two cohorts are summarized in Table 1. There were 1539 daytime deliveries and 1288 nighttime deliveries. The daytime birth cohort had a significantly higher rate of Cesarean delivery and a higher mean birth weight. There was no significant difference in the primary outcome of administration of respiratory resuscitation in the first 30 minutes of life (aRR 1.03, 95% CI 0.86-1.24, p=0.73). Secondary outcomes, including administration of surfactant and NICU admission, were also comparable between the groups (Table 2). Of infants who received surfactant, the average duration of time to surfactant administration was not significantly different between daytime versus nighttime births. Previous studies have inconsistently demonstrated an association of delivery time of day with neonatal morbidity and mortality in early preterm and term infants. Here, we show that in late preterm infants, daytime compared to nighttime birth is not associated with increased neonatal morbidity.View Large Image Figure ViewerDownload Hi-res image Download (PPT)