Effect Of Late Preterm Birth Research Articles

Understanding Gaps in Developmental Screening and Referral.

* Abbreviations: AAP — : American Academy of Pediatrics EI — : early intervention In this issue of Pediatrics , Lipkin et al1 describe trends in pediatrician-reported developmental screening and referral practices between 2002 and 2016. The authors compare data across serial American Academy of Pediatrics (AAP) Periodic Surveys conducted in 2002, 2009, and 2016. They demonstrate that pediatricians’ self-reported use of formal developmental screening tools increased from 21% in 2002 to 63% in 2016 and that referral of patients identified as at risk for developmental delay to early intervention (EI) services increased concomitantly from 41% to 59%. Their data, however, also suggest that in 2016, more pediatricians considered lack of available treatment options to be a barrier to screening than did so in 2002 (21% vs 9%). Although developmental screening, surveillance, and referral to services has long been an important aspect of pediatric primary care, the AAP issued its first policy statement calling for universal developmental screening in 2001.2 The unique sampling frames queried with each Periodic Survey included in the current study preclude a true longitudinal analysis of individual-level practice changes; however, the current study represents an important barometer of screening and referral practices over the nearly 20 years since the AAP’s initial policy … Address correspondence to Mei Elansary, MD, MPhil, Division of General Pediatrics, School of Medicine, Boston University, 801 Albany St, Boston, MA 02118. E-mail: mei.elansary{at}bmc.org

Effect of late preterm birth on lung clearance index and respiratory physiology in school-age children.

We hypothesized that former late preterm (LP) children have abnormal pulmonary physiology parameters, including uneven ventilation distribution, due to premature disruption of normal lung development. A cross-sectional study evaluating former LP children at the age of 6 to 12 years as compared to term controls. Demographics and child's and family history of asthma/atopy/smoking were recorded. The outcome parameters were spirometry, multiple breath washout (MBW) measurement by lung clearance index (LCI), 6-minute walk test (6MWT), symptoms related to asthma and allergy, and Godin Leisure-Time Exercise Questionnaire. Twenty-nine former LP were compared to 30 term-control children (mean age, 8.2 ± 1.7 and 8.8 ± 1.8 years, respectively). LP had reduced forced expiratory volume in the first second (FEV1) and forced vital capacity (FVC) compared to term controls (FEV1 1.59 ± 0.48 vs 1.80 ± 0.39 L, P = 0.005 and FVC 1.73 ± 0.45 vs 1.99 ± 0.49 L, P = 0.009). There were no differences between the two groups regarding FEV1/FVC, forced expiratory flow between 25 and 75 (FEF25-75), LCI (7.10 ± 0.79 vs 6.96 ± 0.75, P = 0.50), 6MW distance, and weekly leisure-activity score. Former LP children had more episodes of wheezing and greater use of asthma medication. This pilot study suggests that LP have lower pulmonary function tests (PFTs) but not ventilation inhomogeneity measured by LCI or functional disturbance. It is unclear if the differences in PFTs are due to late prematurity by itself or are the consequence of maternal and neonatal factors associated with LP. Further larger studies are required to assess the long-term respiratory consequences of LP birth.

Emotional and behavioral outcomes and quality of life in school-age children born as late preterm: retrospective cohort study.

AimTo determine the effect of late preterm birth and treatment at the intensive care unit (ICU) on school-age children’s emotional and behavioral problems and quality of life (QoL).MethodsEmotional and behavioral problems and QoL were investigated in 6-12-year-olds who were born late preterm at the University Hospital Center Split in the period from January 2002 to March 2008. The study included 126 late preterm children treated in ICU (LP-ICU group), 127 late preterm children not treated in ICU (LP-non-ICU group), and 131 full-term children treated in ICU (FT-ICU group). Emotional and behavioral difficulties were assessed using the Child Behavior Checklist. QoL was evaluated with the Royal Alexandra Hospital for Children Measure of Function questionnaire. The data was collected via telephone interview with mothers during 2014.ResultsLate preterm children had a nearly 5-fold risk for internalizing problems in comparison with FT-ICU children (OR 4.76, 95% confidence interval [CI] 2.37-9.56 and OR 4.82, 95% CI 2.25-10.37 in LP-ICU and LP-non-ICU children, respectively). They also had a greater risk for externalizing problems (OR 3.08, 95% CI 1.44-6.61 and OR 2.68, 95% CI 1.14-6.28, respectively) and total problems (OR 6.29, 95% CI 2.86-13.83 and OR 7.38, 95% CI 3.08-17.69, respectively) and a considerably increased risk for lower QoL (OR 12.79, 95% CI 5.56-29.41 and OR 5.05, 95% CI 2.04-12.48, respectively).ConclusionChildren born late preterm had a greater risk for emotional and behavioral problems and lower QoL during childhood than their full-term born peers and they experienced serious health problems upon birth.

Effects of Late Preterm Birth on the Incidence of Developmental Delays among Children at 3 Years of Age: A Matched-Pair Case-Control Study

Purpose: To investigate the relationship between preterm delivery and developmental outcomes in children born at 34 - 36 weeks of gestation (late preterm period). Methods: This study reviewed the cases of singleton late preterm children and full-term (38 - 40 weeks of gestation) children born at Showa University Hospital. The developmental outcomes at 3 years of age were assessed based on the results of questionnaires sent to the families by mail. In addition, the incidence of developmental delays was compared between the late preterm and full-term children. In the full-term control group, perinatal characteristics (neonatal gender, Apgar score, Cesarean delivery, birth weight t-test was applied. A p-value of

Considerations on the late-preterm newborn with cardiac problems

Focus on the late preterm birth (LPB) and critical congenital heart defects (CCHD) Data on outcomes of CCHD specifically in late preterm infants are exceedingly scarce. The preterm newborn with associated complex CHD presents many intricate problems to clinicians who take care (neonatologist, cardiologist, cardiothoracic surgeon). Therapies used for the preterm neonate without heart disease frequently need to be altered in the presence of heart disease and those needed for management of heart disease may need to be altered because of prematurity. The population of newborn born preterm is at higher risk for postoperative death and short and long term complications than term newborn with the same CHD and the causes of this are multifactorial. Technical issue related to small cardiac structure, immaturity of other organ systems, decreased nutritional and cardiac reserve, increased risks of bleeding, abnormal chest wall mechanics after sternotomy can all together account for this epidemiologic data. In past years these findings were related in particular to low-birth weight infants and conventional management was oriented to await a threshold weight in order to reduce bypass-related morbidities. From 1990 rates of LPB have risen and now account for 75% of all preterm births. Whether late preterm infants with CHD, who may be only marginally more immature than their term counterparts, remain at risk for adverse outcome in unclear. Some recent papers do demonstrate the independent effect of LPB on mortality and morbidity if a CHD is present and this issue emerge as an important factor for a correct counseling. Natarajan have observed that the weight at surgical intervention was significantly lower and age higher in the late preterm infants compared to those delivered at term. Late preterm infants had significantly higher rates of NEC and seizures, with a greater risk of supplemental oxygen and tube feeding at discharge. Costello have examined mortality and morbidity stratified by gestational age, reporting for LPB group with CHD an hospital mortality rate of 16.4% compared to 2.6-8% in the term group. The exact mechanism of this vulnerability remains unclear although functional immaturity of the lung and the brain are plausible aetiologies. Altered intrinsic cardiac mechanism could play a role in adverse outcome of late preterm with CHD. Gestational age at delivery can be a risk factor over which clinicians might have some control. Before birth the challenge is planning the time and the place for the delivery of a foetus with CHD. After birth the challenge is not waiting for obtain an arbitrary correct weight for surgery but working in a complex team to discuss each case in order to maximize outcome. Domande inerenti la relazione del Dott. Stefano Fiocchi

Subtle adverse effects of late preterm birth: A cautionary note.

Late preterm birth increases risk of perinatal health complications that typically resolve in the short term. Thus, early elective delivery is thought to have no long-term effects. Whether there is increased risk of adverse psychological outcomes that emerge in early childhood remains uncertain. The authors compared intellectual, neuropsychological, and behavioral outcomes in 278 late preterm (35-36 weeks) and 192 term (37-41 weeks) participants at age 3 years recruited from a single center, using analysis of variance, analysis of covariance, and regression analyses. Late-preterm participants were further subgrouped by admission to the neonatal intensive care unit (NICU; n = 202) or a well-baby unit (n = 76). Analyses included 132 additional participants born at 34 weeks. Late preterm participants had lower general conceptual ability (GCA; i.e., IQ); lower verbal, nonverbal, spatial, visuomotor, and dexterity scores; and poorer adaptability than term participants (p < .01; -0.271 to -0.511 SDs). Gestational age was the most important predictor of these subtle outcomes, not neonatal medical variables; no differences were found between NICU admitted and nonadmitted late-preterm groups. A 1-week increase in gestational age resulted in a 1.941 increase in GCA (d = 0.127). Gestation is a developmental continuum best not interrupted during its natural course. Our data showing subtle but appreciable effects have important implications for obstetric practice and parental decision making regarding early elective delivery in the absence of maternal or fetal adverse indications.

The Effect of Late Preterm Birth on Mortality of Infants with Hypoplastic Left Heart Syndrome

We evaluated the effect of late preterm (34 to 36 weeks' gestation) delivery on hospital mortality of infants with hypoplastic left heart syndrome (HLHS). Retrospective review of records of infants born at or after 34 weeks with no other lethal anomalies, cared for in a single tertiary perinatal center between 2002 and 2009. Factors associated with death prior to discharge from the hospital were ascertained using univariate and multivariate analyses. Of the 243 infants with HLHS, 35 were late preterm and 208 were ≥37 weeks (term). Using logistic regression analysis, late preterm delivery (odds ratio [OR] 2.95; 95% confidence interval [CI] 1.35 to 6.45), the presence of other major cardiac defects (OR 3.76; 95% CI 1.31 to 10.81), and the presence of noncardiac congenital anomalies (OR 6.13; 95% CI 1.43 to 26.22) were independently associated with hospital death. Late preterm birth of infants with HLHS was independently associated with an increased risk of hospital death compared with those delivered at term.

The Effect of Late Preterm Birth on Survival of Infants with Major Congenital Heart Defects

Aim: We evaluated the effect of late preterm delivery on hospital mortality of newborn infants with major congenital heart defects (CHD).

Effect of late preterm birth on longitudinal lung spirometry in school age children and adolescents

BackgroundRates of preterm birth have increased in most industrialised countries but data on later lung function of late preterm births are limited. A study was undertaken to compare lung function...

The effect of late preterm birth on mortality of infants with major congenital heart defects

We evaluated the effect of late preterm delivery (34 to 36 weeks) on hospital mortality of infants with congenital heart defects (CHDs). Retrospective record review of infants with major CHD born at or after to 34 weeks, cared for in a single tertiary perinatal center between 2002 and 2009. Factors associated with death before discharge from the hospital were ascertained using univariate and multivariate analyses. Of the 753 infants with CHD, 117 were born at late preterm. Using logistic regression analysis, white race (OR; 95% CI) (0.60; 0.39 to 0.95), late preterm delivery (2.70; 1.69 to 4.33), and need for intubation in the delivery room (3.15; 1.92 to 5.17) were independently associated with hospital death. Late preterm birth of infants with major CHDs was independently associated with increased risk of hospital death compared with delivery at more mature gestational ages.

Late Preterm Infants: Birth Outcomes and Health Care Utilization in the First Year

To distinguish the effects of late preterm birth from the complications associated with the causes of delivery timing, this study used propensity score-matching methods on a statewide database that contains information on both mothers and infants. Data for this study came from Arkansas Medicaid claims data linked to state birth certificate data for the years 2001 through 2005. We excluded all multiple births, infants with birth defects, and infants at <33 weeks of gestation. Late preterm infants (LPIs) (34 to 36 weeks of gestation) were matched with term infants (37-42 weeks of gestation) according to propensity scores, on the basis of infant, maternal, and clinical characteristics. A total of 5188 LPIs were matched successfully with 15303 term infants. LPIs had increased odds of poor outcomes during their birth hospitalization, including a need for mechanical ventilation (adjusted odds ratio [aOR]: 1.31 [95% confidence interval [CI]: 1.01-1.68]), respiratory distress syndrome (aOR: 2.84 [95% CI: 2.33-3.45]), and hypoglycemia (aOR: 1.60 [95% CI: 1.26-2.03]). Outpatient and inpatient Medicaid expenditures in the first year were both modestly higher (outpatient, adjusted marginal effect: $108 [95% CI: $58-$158]; inpatient, $597 [95% CI: $528-$666]) for LPIs. LPIs are at increased risk of poor health-related outcomes during their birth hospitalization and of increased health care utilization during their first year.

Late Preterm Birth and Neonatal Outcome: Is 37 Weeks’ Gestation a Threshold Level or a Road Marker on the Highway of Perinatal Risk?

BirthVolume 37, Issue 2 p. 169-171 Late Preterm Birth and Neonatal Outcome: Is 37 Weeks’ Gestation a Threshold Level or a Road Marker on the Highway of Perinatal Risk? Russell S. Kirby PhD, MS, FACE, Russell S. Kirby PhD, MS, FACE Russell Kirby is a Professor and Marrell Endowed Chair in the Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, Florida, and Martha Wingate is an Assistant Professor in the Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA.Search for more papers by this authorMartha S. Wingate DrPH, Martha S. Wingate DrPH Russell Kirby is a Professor and Marrell Endowed Chair in the Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, Florida, and Martha Wingate is an Assistant Professor in the Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA.Search for more papers by this author Russell S. Kirby PhD, MS, FACE, Russell S. Kirby PhD, MS, FACE Russell Kirby is a Professor and Marrell Endowed Chair in the Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, Florida, and Martha Wingate is an Assistant Professor in the Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA.Search for more papers by this authorMartha S. Wingate DrPH, Martha S. Wingate DrPH Russell Kirby is a Professor and Marrell Endowed Chair in the Department of Community and Family Health, College of Public Health, University of South Florida, Tampa, Florida, and Martha Wingate is an Assistant Professor in the Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA.Search for more papers by this author First published: 18 May 2010 https://doi.org/10.1111/j.1523-536X.2010.00399.xCitations: 15 Address correspondence to Russell S. Kirby, PhD, MS, FACE, Department of Community and Family Health, University of South Florida College of Public Health, 13201 Bruce B. Downs Blvd, MDC56, Tampa, FL 33612, USA. e-mail:rkirby@health.usf.edu COMMENTARY ON:: Petrini JR, Dias T, McCormick MC, Massolo ML, Green NS, Escobar GJ. Increased risk of adverse neurological development for late preterm infants. J Pediatr 2009;154:169–176.Shapiro-Mendoza CK, Tomashek KM, Kotelchuck M, Barfield W, Nannini A, Weiss J, Declercq E. Effect of late-preterm birth and maternal medical conditions on newborn morbidity risk. Pediatrics 2008;121:e223–e232. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Citing Literature Volume37, Issue2June 2010Pages 169-171 RelatedInformation

Late preterm birth is a risk factor for growth faltering in early childhood: a cohort study

BackgroundRates of preterm birth are increasing worldwide and this increase is mostly due to infants born between 34 and 36 weeks of gestational age, the so-called "late preterm" births. The aim of this study was to assess the effect of late preterm birth over growth outcomes, assessed when children were 12 and 24 months old.MethodsIn 2004, all births taking place in Pelotas (Southern Brazil) were recruited for a cohort study. Late preterm (34/0-36/6 weeks of gestational age) and term children (37/0-42/6 weeks) were compared in terms of weight-for-age, length-for-age and weight-for-length z-scores. Weight-for-age, length-for-age and weight-for-length z-scores below -2 were considered, respectively, underweight, stunting and wasting. Singleton newborns with adequate weight for gestational age at birth, successfully followed-up either at 12 or 24 months of age were analyzed and adjusted odds ratios with 95% confidence intervals calculated through logistic regression.Results3285 births were included, 371 of whom were late preterm births (11.3%). At 12 months, prevalence of underweight, stunting and wasting were, respectively, 3.4, 8.7 and 1.1% among late preterm children, against 1.0, 3.4 and 0.3% among term children. At 24 months, correspondent values were 3.0, 7.2 and 0.8% against 0.8, 2.9 and 0.4%. Comparing with the term children, adjusted odds of being underweighted among late preterm children was 2.57 times higher (1.27; 5.23) at 12 months and 3.36 times higher (1.56; 7.23) at 24; of being stunted, 2.35 (1.49; 3.70) and 2.30 (1.40; 3.77); and of being wasted, 3.98 (1.07; 14.85) and 1.87 (0.50; 7.01). Weight gain from birth to 12 and 24 months was similar in late preterm and term children, whereas length gain was higher in the former group in both periods.ConclusionLate preterm children grow faster than children born at term, but they are at increased risk of underweight and stunting in the first two years of life. Failure to thrive in the first two years may put them at increased risk of future occurrences of serious morbidity in late childhood and of chronic disease development in adult life.

Effect of late preterm birth on neonatal morbidity risk

Effect of late preterm birth on neonatal morbidity risk

Effect of Late-Preterm Birth and Maternal Medical Conditions on Newborn Morbidity Risk

Late-preterm infants, born at 34 to 36 weeks’ gestation, make up nearly three-fourths of all preterm births in the United States. The proportion of such infants among singleton live births has risen by more than 10% in the past decade, largely because of more frequent obstetrical interventions for maternal complications or preexisting medical disorders. This study compared newborn morbidity risk in late-preterm and term (37–41 weeks’ gestation) infants born in Massachusetts in the years 1998–2003. Infant and maternal hospital discharge records were taken from the Massachusetts Pregnancy to Early Life Longitudinal data system. Eight maternal medical conditions were analyzed for their effects on newborn morbidity: hypertensive disorders of pregnancy, diabetes, antepartum hemorrhage, lung disease, infection, cardiac disease, renal disease, and genital herpes. The final study population included 26,170 late-preterm infants and 377,638 born at term. Late-preterm infants were 7 times more likely than term infants to have morbidity at birth (22.2% vs. 3.0%). Morbidity rates approximately doubled for each gestational week earlier than 38 weeks. Compared with infants born at 40 weeks’ gestation, those born at 34 weeks’ gestation had a 20-fold increase in risk, and infants born at 35 and 36 weeks’ gestation had, respectively, 10 times and 5 times the morbidity risk. Among both term and late-preterm infants, the incidence of morbidity was higher in males and those whose mothers were 40 or more years of age, were primiparas or grand multiparas, or smoked while pregnant. Late-preterm infants whose mothers had any of the 8 specified disorders were at higher risk for newborn morbidity than were similarly exposed near term or term infants. Infants exposed to antepartum hemorrhage or hypertensive disorders of pregnancy were especially at risk. The proportion of infants with morbidity increased with the number of maternal morbid conditions. Both late-preterm birth and maternal medical disorders are independent risk factors for newborn morbidity and, when combined, greatly increase the risk of newborn morbidity compared with infants escaping exposure to either of these risks.

Effect of Late-Preterm Birth and Maternal Medical Conditions on Newborn Morbidity Risk

Late-preterm infants (34-36 weeks' gestation) account for nearly three quarters of all preterm births in the United States, yet little is known about their morbidity risk. We compared late-preterm and term (37-41 weeks' gestation) infants with and without selected maternal medical conditions and assessed the independent and joint effects of these exposures on newborn morbidity risk. We used 1998-2003, population-based, Massachusetts birth and death certificates data linked to infant and maternal hospital discharge records from the Massachusetts Pregnancy to Early Life Longitudinal data system. Newborn morbidity risks that were associated with gestational age and selected maternal medical conditions, both independently and as joint exposures, were estimated by calculating adjusted risk ratios. A new measure of newborn morbidity that was based on hospital discharge diagnostic codes, hospitalization duration, and transfer status was created to define newborns with and without life-threatening conditions. Eight selected maternal medical conditions were assessed (hypertensive disorders of pregnancy, diabetes, antepartum hemorrhage, lung disease, infection, cardiac disease, renal disease, and genital herpes) in relation to newborn morbidity. Our final study population included 26,170 infants born late preterm and 377,638 born at term. Late-preterm infants were 7 times more likely to have newborn morbidity than term infants (22% vs 3%). The newborn morbidity rate doubled in infants for each gestational week earlier than 38 weeks. Late-preterm infants who were born to mothers with any of the maternal conditions assessed were at higher risk for newborn morbidity compared with similarly exposed term infants. Late-preterm infants who were exposed to antepartum hemorrhage and hypertensive disorders of pregnancy were especially vulnerable. Late-preterm birth and, to a lesser extent, maternal medical conditions are each independent risk factors for newborn morbidity. Combined, these 2 factors greatly increased the risk for newborn morbidity compared with term infants who were born without exposure to these risks.