Morbidity In Late Preterm Infants Research Articles

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

Comparison of respiratory morbidity in late preterm infants and intrauterine growth retarded infants at school-age

Objective: We aimed to determine respiratory morbidity of late preterm infants versus infants with intrauterine growth retardation (IUGR) at school-age. Patients and Methods: Late preterm appropriate for gestational age (AGA) infants (34-36, 6/7 weeks) (Group 1), IUGR infants (Group 2), extremely preterm AGA (Group 3) and term AGA infants (Group 4) born between 2004 and 2008 were included in this casecontrol study and assessed for respiratory morbidity at school-age. We evaluated the impact of late preterm compared with IUGR and term gestation on respiratory morbidity by using validated American Thoracic Society – Division of Lung Diseases (ATS-DLD-78-C) and the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaires. Questionnaires on wheezing, infectious respiratory morbidity, and physician-diagnosed asthma panels were constituted and groups were compared. Results: A total of 160 patients were enrolled in the study and 97 (60.6%) of them were boys. Respiratory morbidities at schoolage were found to be significantly higher in both late preterm and IUGR groups when compared to term controls. Each weekly increase in gestational age reduced the risk for wheezing episodes (OR perGW:0.82,95%CI:0.71-0.97, p:0.02). Regarding infectious respiratory morbidities, there was a significant increase when the number of people living at home increased (OR perperson:1.79,95%CI:1.12-2.87, p:0.01), and a decrease in female gender (OR:0.41,95%CI:0.17-0.99, p:0.04) and in the week of gestation (OR perGW:0.84,95%CI:0.71-1.00, p:0.04). Atopic dermatitis (OR:5.26,95%CI:1.57-17.69, p<0.01) and maternal asthma (OR:5.38,95%CI:1.17-24.60, p:0.03) history were found to be risk factors for asthma. Conclusion: Being IUGR may be an important risk factor for respiratory morbidity at school-age. Further studies are needed on this subject.

Is Less Invasive Surfactant Administration a Beneficial Method for Late Preterm Infants?

Late preterm infants (LPIs) have increased steadily in all newborns delivery and they are the largest patient group requiring admission to the neonatal intensive care unit. Surfactant treatment is frequently used in LPIs in case of respiratory distress, but the procedure and the timing of surfactant administration are not well-known. We aimed to evaluate the effect of surfactant administration techniques on pulmonary outcomes in LPIs with respiratory distress. In this retrospective study, we compared the effects of the less invasive surfactant administration (LISA) technique and conventional treatment on respiratory and other morbidities in LPIs who have respiratory difficulties. We named these two groups as the LISA group and the conventional group (CG). Comparison of the mechanical ventilation (MV) rates between the groups was the primary outcome of our study. There were 25 LPIs in each group. The duration of nasal continuous positive airway pressure (CPAP) and oxygenation were similar in both groups. The rate of MV and the duration of MV (P=0.004 and P=0.02) were lower in the LISA group. Also, the need for more than 1 dose of surfactant was higher in the MV requiring group, although it was not statistically significant between the groups (P=0.21). Using the LISA technique for surfactant instillation reduces any MV requirement. LISA is a very useful and reliable technique in experienced hands in LPIs as in very preterm infants.

English

BACKGROUND Late preterm infants are less mature physiologically and have poor compensatory responses when compared to term infants. Recent studies have implied increased morbidities in late preterm infants and higher rate of hospital admission during neonatal period. Multiple maternal risk factors lead to the increasing incidence of late preterm births. We wanted to study the morbidity and mortality profile of late preterm infants compared to term infants. METHODS The study was conducted in the special newborn care unit (SCNU) of Silchar Medical College and Hospital. The study population comprised of 175 late preterm and 175 term babies admitted in SCNU. It was a cross sectional study. RESULTS In this study 175 late preterm neonates were compared with 175 term neonates. Late preterm babies were at increased risk of hypoglycemia (P value = 0.0130), neonatal jaundice (P = 0.021), culture positive sepsis (P = 0.001), respiratory distress (P = 0.000), hypocalcaemia (P = 0.030), difficulty in feeding (P = 0.000) and birth asphyxia (P = 0.013), longer hospital stay and mortality (P = 0.009) when compared to term babies. In babies of mothers with oligohydramnios and pregnancy induced hypertension, preterm babies had significant morbidity compared to term babies. CONCLUSIONS Late preterm babies have an increased risk of morbidity and mortality when compared to term neonates and need special care. Premature rupture of membranes, antepartum hemorrhage and pre-eclampsia are the main maternal complications leading to premature delivery of the baby. KEY WORDS Late Preterm, Preeclampsia, Oligohydramnios, Morbidity

A prospective study comparing the morbidities of late preterm and term infants in the neonatal period in a tertiary care hospital

Background: In obstetric practice, 34 completed weeks is considered as maturational milestone for the fetus. Despite relatively large size and apparent functional maturity, late preterm infants are at increased risk for neonatal morbidity compared with full term infants. Aim of the study was to study the incidence of late preterm births in a tertiary care hospital in Trichy, Tamil Nadu and to study the pattern of neonatal morbidities in late preterm infants and to compare it with term infants.Methods: Hospital based prospective study was conducted from April 2019 to March 2020. Total 470 late preterm infants were included in our study. All infants enrolled in the study were followed up daily till discharge and after discharge, all infants were than reviewed at 15 and 28 days in a well-baby clinic.Results: There were a total of 1941 live births during the study period. Of these, 470 (24.2%) were late preterm and 1263 (65%) were term births. Late preterm infants accounted for 71.1% of preterm birth. Late preterm infants were at significantly higher risk for overall morbidity due to any cause, respiratory 22.1%, neonatal jaundice 62%, sepsis 4%, hypoglycemia 8.9%, hospital readmission 8.1%. 63% of late preterm infants were readmitted for jaundice.Conclusions: The incidence of late preterm birth was 24%. Late preterm infants had a higher incidence of jaundice, sepsis and respiratory morbidities. Late preterm infants had a longer hospital stay. They were also more likely to get readmitted in the hospital when compared to term infants.

Short-term antenatal corticosteroid increases risk of respiratory morbidity in late preterm infants

Short-term antenatal corticosteroid increases risk of respiratory morbidity in late preterm infants

Influence of a Breastfeeding Coaching Program on the Breastfeeding Rates and Neonatal Morbidity in Late Preterm Infants.

PurposeThis study aimed to determine the influence of a breastfeeding coaching program (BCP) for mothers of late preterm infants (LPIs) on the breastfeeding rate and neonatal morbidity within 1 month after discharge.MethodsThis was a non-randomized quasi-experimental study with a time series design. The participants were 40 LPIs and their mothers who were hospitalized in a neonatal intensive care unit at a university hospital. Nineteen LPIs were assigned to the control group, and 21 to the experimental group. The mothers of the LPIs in the experimental group received the BCP once on the discharge day and then once a week for 1 month. Neonatal morbidity was defined as an outpatient department or emergency room visit due to an LPI's health problem.ResultsThe breastfeeding rate in the experimental group was significantly higher than in the control group at the fourth week after discharge (x2=7.17, p=.028). Five and two LPIs in the control group and the experimental group, respectively, visited a hospital due to neonatal jaundice. Neonatal morbidity was not significantly different between the two groups (x2=1.95, p=.164).ConclusionThe BCP was useful for improving the breastfeeding rates of LPIs and may have potential to reduce neonatal morbidity.

324: Gestational age and circumstances at delivery affect neonatal outcomes among late preterm infants.

Late preterm (LP) infants are often considered as a homogeneous population more susceptible to neonatal morbidities, despite significant differences due to gestational age at delivery (GA9 and circumstances prompting parturition. Therefore, we intended to asses if among LP newborns, timing of delivery and circumstances at parturition could affect early neonatal outcomes. Prospective, area based cohort study of neonatal morbidity and mortality among singleton infants born between 34+0 and 36+6 weeks, at 19 L&D units in Emilia Romagna county, Italy, during 2013-15. After univariate analysis, multivariate logistic regression was used to determine the OR af a composite adverse neonatal outcome (including Apgar 5' ≤ 3, umbilical-cord-blood arterial pH < 7.0, RDS, TTN, hypoglycemia, sepsis, confirmed seizures, stroke, IVH, cardiopulmonary resuscitation, invasive respiratory support and hospitalization ≥ 5 days) according to GA at delivery (34, 35 or 36 weeks) and circumstances at parturition (spontaneous LP labor, pPROM or indicated LP delivery), while accounting for other maternal and prenatal characteristics. Among 1897 births, 302, 505 and 1061 infants were born at 34, 35 and 36 weeks, respectively. There were no neonatal deaths. According to univariate analysis (table 1), the composite adverse neonatal outcome significantly decreased with GA (p< 0.01), while circumstances at parturition did not differ when birth occurred at 34, 35 or 36 weeks. Adjusted OR for perinatal morbidities were higher at 34 (p< 0.01) and 35 (p< 0.01) weeks when compared to 36 weeks deliveries, and among indicated LP births (p< 0.01) (table 2). Neonatal morbidities in LP infants differ according to both GA and indication for delivery. Such differences may be useful when counseling patients and planning interventions.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Neonatal Morbidity in Late Preterm Infants Associated with Intrauterine Growth Restriction.

AIM:This study aims to compare the neonatal morbidity of Intrauterine growth restricted (IUGR) Late Preterm (LP) babies, to those born Late Preterm but evaluated as Appropriate for Gestational Age (AGA).METHODS:The study is a 2-year prospective one that used data from the Neonatal Intensive Care Unit (NICU) charts of LP neonates born in our tertiary maternity hospital “Koço Gliozheni” in Tirana. Congenital anomalies and genetical syndromes are excluded. Neonatal morbidity of IUGR Late Preterm is compared to those born Late Preterm but evaluated as AGA. OR and CI, 95% is calculated.RESULTS:Out of 336 LP babies treated in NICU, 88 resulted with IUGR and 206 AGA used as a control group. We found significantly higher morbidity in the IUGR group for hypoglycemia, polycythemia, feeding intolerance, birth asphyxia and seizures, secondary sepsis have higher morbidity but the difference is not significant. No differences were found for hyperbilirubinemia in both groups. No neonatal deaths were observed in both groups.CONCLUSION:Our study showed that late preterm IUGR has a significantly higher risk for neonatal morbidity when compared to late preterm AGA babies.

Does the Use of Antenatal Corticosteroids Decrease Levels of Neonatal Hyperbilirubinemia in Preterm Infants? [15K

INTRODUCTION: The use of prenatal corticosteroids for pregnant women between 34-36 6/7 weeks of pregnancy is recommended to reducing the morbidity of late preterm infants. METHODS: This is a secondary analysis of a randomized clinical trial conducted to determine the effectiveness of corticosteroids in reducing respiratory disorders in infants born at 34-36 weeks' gestation Trial registration Clinical Trials NCT00675246. This study was approved by IRB and all participants signed an informed consent term. RESULTS: Of 245 preterm infants, the number of newborns with gestational age 34, 35 and 36 was 30 (12.2%), 110 (45.1%), and 105 (42.7%), respectively. Jaundice occurred in 150 (62.5%) newborns and 70 among them required phototherapy during hospitalization. Late preterm infants exposed to corticosteroids started treatment with lifetime of 61.2± 33.6 h vs. 48.3± 25.3 h (p = 0.03) with similar levels of bilirubin (12.1± 3.2 mg/dL vs. 12.8± 3.7 mg/dL, p = 0.38) when compared to the control group. They required less treatment compared to the placebo group (n = 27 vs. n = 42, p = 0.025), and spent less days on phototherapy (1.7± 1.7 vs. 2.6± 2.2, p = 0.05). CONCLUSION: Late preterm infants exposed to prenatal corticosteroids had less need for phototherapy and shorter treatment. Also, they developed elevated level of bilirubin later. This result suggests that prenatal corticosteroids decrease the levels of hyperbilirubinemia in late preterm infants.

Underlying maternal and pregnancy-related conditions account for a substantial proportion of neonatal morbidity in late preterm infants.

We studied the impact of maternal and pregnancy-related conditions and the effect of gestational age itself, on the health of infants born late preterm. Singletons born in gestational weeks 34 + 0 to 41 + 6 in 1995-2013 in the southern region of Sweden were identified from a perinatal register. We found 14 030 infants born late preterm and 294 814 born at term. A hierarchical system was developed to examine the impact of pregnancy complications. The outcomes studied were as follows: neonatal death, central nervous system (CNS) or respiratory disease, infection, neonatal admission and respiratory support. Odds ratios (OR) and 95% confidence intervals (95% CI) were obtained using logistic regression analyses. Late preterm infants were at increased risk for all outcomes compared to term infants, with adjusted ORs from 13.1 (95% CI: 12.7-13.6) for neonatal admission to 2.3 (95% CI: 1.8-2.9) for infections. Late preterm birth after preterm prelabour rupture of membranes was associated with an overall lower risk compared to late preterm births due to other causes. Exposure to antepartum haemorrhage or maternal diabetes increased the risk for CNS and respiratory morbidity. Morbidity decreased in late preterm infants with increasing gestational age. Underlying conditions accounted for a substantial part of the morbidity.

Respiratory morbidity in late preterm infants.

Late preterm delivery (74% of all preterm births) increases the incidence of respiratory pathology, namely respiratory distress syndrome (RDS), transient tachypnea of the newborn (TTN) and the need of ventilator support when compared to term delivery. The aim is to evaluate the respiratory morbimortality in late preterm infants and the risk factors associated with RDS and TTN. Descriptive retrospective study of all newborns of 34+0 to 36+6 weeks of gestational age, born at our center between September 1, 2012 and August 31, 2015. Those with major malformations, chromosomopathies, hydrops fetalis and congenital TORCH infection were excluded. A total of 498 newborns were studied, 44 (8.83%) of them with either RDS or TTN. Respiratory morbidity was significantly associated with lower gestational age, male gender, caesarean section, exposure to peripartum antibiotics, overweighed and nulliparous mothers. RDS newborns had a significantly higher need for resuscitation, endotracheal intubation, oxygen therapy, early invasive ventilation, parenteral nutrition and a longer NICU stay when compared to newborns with TTN. 55% of the patients with RDS had 35+0 to 36+6 weeks of gestational age, moderate or severe RDS and required mechanical ventilation; six needed surfactant. Caesarean section and resuscitation with ETT were independent risk factors for respiratory morbidity. Late preterm remain at risk for adverse respiratory outcomes, particularly newborns delivered after 35 weeks, whose mothers are not given ACS and still have considerable morbidity. Growing evidence supports the possibility of extending the management window further into the LPT period. Caesarean section was an independent risk factor for respiratory morbidity and efforts should be undertaken to reduce the procedure rate.

Morbidities and follow-up of admitted late preterm infants

Background: The objective of the study was to document the neonatal morbidities in late preterm infants admitted to tertiary care newborn centre. Methods: Observational prospective case series study. All late preterm infants during the study period of one year were included. Descriptive statistics and analysis of the morbidities was done. A follow up of 6 months was done to assess growth and development. Results: 100 infants were studied. The admission complaints were respiratory distress (32%), low birth weight care (31%), jaundice (15%), feeding difficulties &amp; lethargy (5%). morbidities included jaundice (68%), hypoglycaemia (38%), septicaemia (24%), respiratory distress syndrome (20%) &amp; transient tachypnea of newborn (15%). 55% of infants with subnormal head growth were identified in follow-up. Conclusions: The most common cause for admission was respiratory distress (32%) within 48 hours of life and jaundice later. Most common morbidity was jaundice (68%).Most of the morbidities could be effectively treated with timely care. Follow up of these infants for early identification and treatment of problems is imperative.

Rooming-in organization to prevent neonatal mortality and morbidity in late preterm infants

Despite most infants born at 34+0 through 36+7 weeks’ gestation are thought to be at low risk during the birth hospitalization and have a neonatal course with no significant complications, they are physiologically and metabolically immature with an higher rates of morbidity and mortality than term infants [1]. Most common medical condition associated with late-preterm births are respiratory distress, apnea, temperature instability, hypoglycemia, hypocalcemia, jaundice, poor feeding, sepsis and finally an higher rates of the hospital readmissions during the neonatal period. These morbidities result in workup for sepsis evaluations, antibiotic therapy, intravenous fluid administration, ventilatory support and increased length of stay with higher hospital costs [2]. Rooming-in organization of late preterms births aims to assess and identify risk factors, prevent and manage potential medical complications during hospitalization. Interventions and practices reccomended are illustred in table ​table11. Table 1 Assessment and care of the late preterm infant [3]. Evidence of physiologic maturity, feeding competency, thermoregulation and absence of medical of medical illness are minimum discharge criteria for late-preterm newborns. Furthermore it’s of great importance to assess educational programs with special instruction and guidance to parents, engaging families in providing appropriate home care after hospital discharge. A long term follow-up arrangements is also recommended to assess and plan early interventions in case of neurodevelopment delay [4]. We conclude that, based on the significant morbidity and mortality of late preterm births, the health care focus on prematurity should be expanded to include the late preterm period.

Acute respiratory morbidity in late preterm infants

Background Late preterm (LP) infants [gestational age (GA): 3436 weeks] are at increased risk of neonatal acute respiratory morbidity compared with term infants (GA: 3741) [1,2]. The observed rate of acute respiratory morbidity, in a population of about 20,000 LP infants, was 10-12% vs 1.4% of term infants [1]. Transient tachypnea of the newborn (TTN) and respiratory distress syndrome (RDS) are the most common diagnosis, with RDS rate reaching 10.5% in infants born at 34 weeks of GA [1,2]. Major causes of respiratory morbidity in LP are: prematurity and birth by Cesarean Section (CS) [1,3]. Material and methods We retrospectively studied 830 LP and moderate preterm (MP) infants (GA: 33-36 weeks) admitted to our unit from June 2009 to December 2013. Infants were classified according to GA: 33 weeks (n = 129), 34 weeks (n = 176), 35 weeks (n = 225), 36 weeks (n = 300). Clinical charts for each patient were reviewed and main diagnosis recorded.

Late prematurity: a systematic review

Objectivethis study aimed to review the literature regarding late preterm births (34 weeks to 36 weeks and 6 days of gestation) in its several aspects. Sourcesthe MEDLINE, LILACS, and Cochrane Library databases were searched, and the references of the articles retrieved were also used, with no limit of time. Data synthesisnumerous studies showed a recent increase in late preterm births. In all series, late preterm comprised the majority of preterm births. Studies including millions of births showed a strong association between late preterm birth and neonatal mortality. A higher mortality in childhood and among young adults was also observed. Many studies found an association with several neonatal complications, and also with long-term disorders and sequelae: breast-feeding problems, cerebral palsy, asthma in childhood, poor school performance, schizophrenia, and young adult diabetes. Some authors propose strategies to reduce late preterm birth, or to improve neonatal outcome: use of antenatal corticosteroids, changes in some of the guidelines for early delivery in high-risk pregnancies, and changes in neonatal care for this group. Conclusionsnumerous studies show greater mortality and morbidity in late preterm infants compared with term infants, in addition to long-term disorders. More recent studies evaluated strategies to improve the outcomes of these neonates. Further studies on these strategies are needed.

Late prematurity: a systematic review

Objectivethis study aimed to review the literature regarding late preterm births (34 weeks to 36 weeks and 6 days of gestation) in its several aspects. Sourcesthe MEDLINE, LILACS, and Cochrane Library databases were searched, and the references of the articles retrieved were also used, with no limit of time. Data synthesisnumerous studies showed a recent increase in late preterm births. In all series, late preterm comprised the majority of preterm births. Studies including millions of births showed a strong association between late preterm birth and neonatal mortality. A higher mortality in childhood and among young adults was also observed. Many studies found an association with several neonatal complications, and also with long-term disorders and sequelae: breastfeeding problems, cerebral palsy, asthma in childhood, poor school performance, schizophrenia, and young adult diabetes. Some authors propose strategies to reduce late preterm birth, or to improve neonatal outcome: use of antenatal corticosteroids, changes in some of the guidelines for early delivery in high-risk pregnancies, and changes in neonatal care for this group. Conclusionsnumerous studies show greater mortality and morbidity in late preterm infants compared with term infants, in addition to long-term disorders. More recent studies evaluated strategies to improve the outcomes of these neonates. Further studies on these strategies are needed.

Prevalence and Morbidity of Late Preterm Infants: Current Status in a Medical Center of Northern Taiwan

"Late preterm" defines infants born at 34(0/7) through 36(6/7) weeks' gestation, which comprise a majority of preterm births. These infants were treated clinically as "near-term" in the past, but recent studies have implied increased morbidities that differentiate late preterm and term infants. The purpose of this study was to examine the prevalence and clinical complications that could be associated with late preterm birth, as compared to term. This was a retrospective cohort study that reviewed infants born in a medical center in Northern Taiwan during a 2-year period between 2008 and 2009. Maternal obstetrical factors, neonatal demographic distributions, and neonatal complications were compared between full-term and late preterm deliveries. During the study period, there were 7998 live births in the institute, including 6507 term and 1491 preterm infants. Of the latter, there were 914 (61.3%) born after 34 weeks' gestation. The Neonatal Intensive Care Unit (NICU) (including a special care nursery) admission rate was higher in late preterm infants when compared to term (36% vs. 2%), and was 74%, 43%, and 21% in infants born at 34, 35, and 36 weeks' gestation, respectively. Compared with term infants, late-preterm infants had longer hospital stay if admitted to NICU (including special care nursery) (17 days vs. 10 days), and they were associated with increased risk of neonatal morbidities, including respiratory distress syndrome (2.6% vs. 0.02%), respiratory distress of other etiologies (16% vs. 2%), culture-proven sepsis (0.7% vs. 0.2%), hypoglycemia (3% vs. 0.4%), temperature instability (0.4% vs. 0.05%), feeding difficulty (2% vs. 0.4%), and hyperbilirubinemia needing phototherapy (14% vs. 3%). Late-preterm infants also had higher hospital readmission rate (4.4% vs. 2.3%, p<0.001) and neonatal mortality rate (0.3% vs. 0.08%, p=0.03). Late-preterm infants have increased risk of neonatal morbidities associated with organ immaturity. The results of this study emphasize the importance of judicious obstetrical decision-making when considering late preterm delivery, and the need to set up anticipatory clinical guidelines for the care of late preterm infants.

The Respiratory Morbidities in Late-preterm Infants Compared with the Early-preterm and Term Infants throughout the First Year of Life

Purpose: We examined the respiratory morbidities in late-preterm infants compared to those of the early-preterm infants and term infants throughout the first year of life. Methods: Data were retrospectively collected for 87 late-preterm, 72 early-preterm, and 608 term infants who were admitted to NICU and the nursery of Busan St. Mary's Medical Center from Jan 2007 to Oct 2009. Results: There were significant differences in the proportions of the out-born infants, twin pregnancy, small for gestational age, and Caesarean section in the three groups (P<0.05). Late-preterm and early-preterm infants had longer duration of hospitalization, larger proportions of respiratory distress syndrome, mechanical ventilation at birth, oxygen therapy after 48 hours of birth, oxygen dependency at 28 days, and continuous positive airway pressure support at 28 days compared to term infants during the neonatal period (P=0.000). Late-preterm infants and early-preterm infants were re-admitted more often than term infants during the first year of life (P=0.000). Also Late-preterm and early-preterm infants had increased chance of respiratory tract illness than term infants (P=0.001). Conclusion: In this study, we demonstrated that there are higher chances of respiratory morbidities in the late-preterm infants than the term infants either during the neonatal period or throughout the first year of life, although early-preterm infants showed greatest respiratory morbidities.

Risk factors of brain injury in late preterm infants

Late preterm is labeled near term. As developmental immaturity, there was higher morbidity in late preterm infants compared with term infants. Especially brain injury, a 3-fold increased risk of cerebralpalsy and significantly higher rates of developmental delay and mental retardation for late preterm infants compared with term infants. In addition, a higher rates of neonatal complications had been documented on late preterm infants. These problems included apnea, hypoglycemia, hyperbilirubinemia, respiratory distress syndome, and poor feeding. It was known that long-term impact of these diseases will result in brain injury. Key words: Late preterm infants; Brain injury; Development; Risk