Outcomes Of Late Preterm Infants Research Articles

The influence of antenatal betamethasone timing on neonatal outcome in late preterm infants: a single-center cohort study.

Many pregnancies continue after antenatal corticosteroid exposure. Since long-term effects on late preterm neonatal outcome remain controversial, it remains unknown whether pregnant women who are at risk for preterm birth during the late preterm period and had prior antenatal corticosteroid exposure would benefit from an additional course of antenatal corticosteroids. We evaluated the need for future trials on this topic by comparing short term effects from antenatal betamethasone to long-term effects. We also examined the value of a risk-adapted approach. We observed neonatal outcomes in late preterm infants (34/0-36/0 weeks of gestation) who were exposed to antenatal betamethasone either up to 10 days prior birth (n = 8) or earlier in pregnancy (n = 89). We examined a real world population from the University Hospital Magdeburg (Germany) between 01 January 2012 and 31 December 2018, and a simulated high-risk population that was derived from the original data. The indicators for relevant adverse outcomes did not differ in the unselected population. In the simulated high-risk population, recent antenatal corticosteroid administration significantly reduced the incidence of relevant cardiorespiratory morbidities (OR = 0.00, p = 0.008), and reduced the number needed to treat from 3.7 to 1.5. The superiority of recent antenatal corticosteroid administration in the late preterm period over earlier exposure strongly depended on the prevalence of respiratory disease. Before considering clinical trials on additional antenatal corticosteroid courses in the late preterm period, antenatal assessment tools to predict respiratory morbidity need to be developed.

Admission and respiratory outcomes of late preterm infants in the setting of high cesarean section deliveries: A single center retrospective analysis

Background Late preterm infants (LPIs) account for most preterm births and are at high risk of developing prematurity-related morbidities. Due to the increasing rate of cesarean section delivery, it is expected that more LPIs with respiratory complications will be admitted to neonatal intensive care units (NICU). Objectives To assess the rate of NICU admission and respiratory complications among LPIs and to compare their outcomes based on the mode of delivery. Patients and Methods The list of all LPIs who were admitted in the period 2015–2020 was reviewed. Data collected about demographic characteristics, delivery information, NICU admission, respiratory complications, respiratory support, length of stay, and readmission. Infants were classified according to their mode of delivery into: vaginal delivery group (VD) and cesarean section group (CS). Results Out of 2236 LPIs included, 321 (14%) were born at 34-week gestation, 1137 (51%) were males. 1243 (56%) were admitted to NICU. The CS group comprised 77% (1719) while the VD group 23% (517). Compared to the VD group, infants in the CS group had a higher rate of NICU admission (57.1% vs. 50.7%, P = 0.006), respiratory distress syndrome (RDS) (22% vs. 17%, P = 0.000), and transient tachypnea of newborn (TTN) (17% vs. 11%, P = 0.019). Also, more babies in the CS group received CPAP (36.2% vs. 24.6%, P = 0.000) and surfactant therapy (6.6% vs. 4.6%, P = 0.02). After logistic regression analysis, CS remains an independent factor for NICU admission (OR 1.3, 95% confidence intervals [CI] 1.1–1.6, P = 0.01), respiratory complications (OR 1.6, 95% CI 1.2–2.2, P = 0.001), CPAP requirement (OR 1.6, 95% CI 1.3–2, P = 0.000), and a longer length of stay > 3 days (OR 1.5, 95% CI 1.2–1.8, P = 0.000). Conclusion The rate of CS delivery among late preterm gestation is very high and alarming. CS delivery of LPI increases the rate of NICU admission, respiratory complications, and the need for respiratory support.

Predictors of adverse short-term outcomes in late preterm infants

BackgroundInfants born between 34 weeks and 36 weeks and 6 days of gestation are defined as late preterm infants (LPIs), and they account for approximately 74% of all premature births. Preterm birth (PB) remains the leading cause of infant mortality and morbidity worldwide.AimTo analyse short-term morbidity and mortality and identify predictors of adverse outcomes in late preterm infants.Patients and methodsIn this retrospective study, we evaluated adverse short-term outcomes of LPIs admitted to the Intensive Care Unit (ICU), Clinic for Children’s Diseases, University Clinical Center Tuzla, between 01.01.2020 and 31.12.2022. The analysed data included sex, gestational age, parity, birth weight, Apgar score (i.e., assessment of vitality at birth in the first and fifth minutes after birth), and length of hospitalization in NICU, as well as short-term outcome data. Maternal risk factors we observed were: age of mother, parity, maternal morbidity during pregnancy, complications and treatment during pregnancy. LPIs with major anatomic malformations were excluded from the study. Logistic regression analysis was used to identify risk factors for neonatal morbidity among LPIs.ResultsWe analysed data from 154 late preterm newborns, most of whom were male (60%), delivered by caesarean Sect. (68.2%) and from nulliparous mothers (63.6%). Respiratory complications were the most common outcome among all subgroups, followed by CNS morbidity, infections and jaundice requiring phototherapy. The rate of almost all of the complications in the late-preterm group decreased as gestational age increased from 34 to 36 weeks. Birth weight (OR: 1,2; 95% CI: 0,9 − 2,3; p = 0,0313) and male sex (OR: 2,5; 95% CI: 1,1–5,4; p = 0,0204) were significantly and independently associated with an increased risk for respiratory morbidity, and gestational weeks and male sex were associated with infectious morbidity. None of the risk factors analysed herein were predictors of CNS morbidity in LPIs.ConclusionA younger gestational age at birth is associated with a greater risk of short-term complications among LPIs, thus highlighting the need for increased knowledge about the epidemiology of these late preterm births. Understanding the risks of late preterm birth is critical to optimizing clinical decision-making, enhancing the cost-effectiveness of endeavours to delay delivery during the late preterm period, and reducing neonatal morbidity.

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)

Uzroci i ishodi lečenja respiratornog distresa kod novorođenčadi kasne preterminske gestacije - iskustvo tercijarnog neonatalnog centra

Introduction/Aim: Respiratory distress (RD) is the most common cause of morbidity in preterm infants. The current study was under-taken to determine causes of RD in late preterm infants, analyze characteristics of RD regarding gestational age, compare different clinical forms of RD and determine the factors influencing the unfavorable outcome of late preterm infants with RD. Methods: The study included infants born between 34 0/7 and 36 6/7 weeks of gestation with RD hospitalized at the Institute for Mother and Child Health Care of Serbia "Dr Vukan Cupic". Demographic and clinical characteristics, clinical signs and course of the disease, the occurrence of complications, as well as quantification of disease severity were analyzed. The outcome was assessed through mortality , duration of mechanical ventilation, and length of hospital stay. Patients were ranked and compared according to gestation and type of RD. Descriptive and analytic statistical methods were used for analyzing the results. Results: The study comprised a total of 65 late preterm newborns with RD, the majority of whom were male (n=44, 67.7%). Respiratory distress syndrome (RDS) (46.2%) and transient tachypnea of the newborn (TTN) (40%) were the most common causes of RD. TTN was most prevalent in neonates in the 36 th gestational week, whether RDS was most present before 35 th gestational week. The average length of hospital stay was 15 days and mortality in the group was 1.5%. Conclusion: The most prevalent causes of RD in late preterm infants are RDS and TTN. Late preterm infants represent a vulnerable group of newborns, with a heightened risk of associated morbidity and mortality.

Postnatal growth of small for gestational age late preterm infants: determinants of catch-up growth

BackgroundFailure to recover growth is a risk reported in late preterm population. This study aimed to evaluate the auxological outcome of late preterm infants and identify factors associated with failure to recover growth.MethodsWe enrolled late preterm infants with birth weight ≤10th percentile, followed up at High-Risk Infant Follow-up Service. We collected data at birth and at follow-up visits. A logistic regression analysis was performed to assess variables independently associated with growth failure.ResultsThe population consisted of 175 preterms. The percentage of children showing no weight recovery was 34% at 36 months. At logistic regression analysis, infants who had not regained weight at 12 months had a higher risk of not regaining weight even at 36 months. The same risk factor was highlighted for length catch-up growth. Moreover, infants fed any human milk at discharge were protected from not achieving both weight and length catch-up growth at 36 months.ConclusionThese results indicate that children born late preterm and small for gestational age could fail to recover weight and stature growth in the first 36 months. The protective effect of human milk on failure to thrive highlights the importance of promoting breastfeeding in this population.ImpactA significant number of SGA late preterms show a failure to recover weight and statural growth.Having experienced intrauterine growth restriction is associated with a greater chance of achieving statural catch-up growth.Being born singleton represents a risk factor for slower weight and height growth velocity.Breastmilk has a protective effect on failure to recover adequate weight and length in preterm SGA infants. This finding highlights the importance of promoting breastfeeding in this population.

Breastfeeding outcomes in late preterm infants: A multi-centre prospective cohort study.

To describe (1) infant feeding practices during initial hospitalisation and up to 6 months corrected age (CA) in infants born late preterm with mothers intending to breastfeed, (2) the impact of early feeding practices on hospital length of stay and (3) maternal and infant factors associated with duration of breastfeeding. We conducted a prospective cohort study of infants born at 34+0 to 36+6 weeks gestational age during 2018-2020. Families were followed up until the infant reached 6 months of age (corrected for prematurity). Feeding practices during the birth hospitalisation, length of initial hospital stay, and the prevalence of exclusive or any breastfeeding at 6 weeks, 3 months, and 6 months CA were examined. Associations between maternal and infant characteristics and breastfeeding at 6 weeks, 3 months and 6 months CA were assessed using multivariable logistic regression models. 270 infants were enrolled, of these, 30% were multiple births. Overall, 78% of infants received only breastmilk as their first feed, and 83% received formula during the hospitalisation. Seventy-four per cent of infants were exclusively breastfed at discharge, 41% at 6 weeks CA, 35% at 3 months CA, and 29% at 6 months CA. The corresponding combined exclusive and partial breastfeeding rates (any breastfeeding) were 72%, 64%, and 53% of babies at 6 weeks CA, 3 months CA, and 6 months CA, respectively. The mean duration of hospitalisation was 2.9 days longer (95% confidence interval (CI) 0.31, 5.43 days) in infants who received any formula compared with those receiving only breastmilk (adjusted for GA, maternal age, multiple birth, site, and neonatal intensive care unit admission). In multivariable models, receipt of formula as the first milk feed was associated with a reduction in exclusive breastfeeding at 6 weeks CA (odds ratio = 0.22; 95% CI 0.09 to 0.53) and intention to breastfeed >6 months with an increase (odds ratio = 4.98; 95% CI 2.39 to 10.40). Intention to breastfeed >6 months remained an important predictor of exclusive breastfeeding at 3 and 6 months CA. Our study demonstrates that long-term exclusive breastfeeding rates were low in a cohort of women intending to provide breastmilk to their late preterm infants, with approximately half providing any breastmilk at 6 months CA. Formula as the first milk feed and intention to breastfeed >6 months were significant predictors of breastfeeding duration. Improving breastfeeding outcomes may require strategies to support early lactation and a better understanding of the ongoing support needs of this population.

The Effect of Incompletely Administered Antenatal Corticosteroids on Neonatal Pulmonary Outcomes in Late Preterm Infants

Purpose: Recent obstetric guidelines recommend the administration of antenatal corticosteroids in pregnant women at risk of delivering infants at a gestational age between 34 and 36 weeks. We examined the effect of incompletely administered antenatal corticosteroids on the neonatal pulmonary outcomes in late preterm infants.Methods: Late preterm infants (34<sup>+0</sup> to 36<sup>+6</sup> weeks gestational age) born at the Seoul National University Bundang Hospital from January 2019 to June 2020 were retrospectively enrolled. We excluded multiple births except twins, those with major congenital anomalies, deaths, or transfers to other hospitals. An incomplete course of antenatal corticosteroids was defined as one in which the first or the second dose of betamethasone was administered within 24 hours before delivery. The rates of neonatal pulmonary morbidities were compared between late preterm infants given incomplete courses antenatal corticosteroids and their peers who not given antenatal corticosteroids; these morbidities included respiratory distress syndrome and transient tachypnea of the newborn, assisted ventilation including invasive mechanical ventilation, nasal continuous positive airway pressure and high-flow nasal cannula, and admission to neonatal intensive care unit.Results: Logistic regression models were constructed while adjusting for factors which were significant in bivariate models. After adjusting for baseline maternal and neonatal characteristics, we found no significant differences in the rates of neonatal pulmonary morbidities, assisted ventilation, or admission to the neonatal intensive care unit between late preterm infants who received incomplete antenatal corticosteroid therapy and their peers who were not given any antenatal corticosteroids.Conclusion: Incompletely administered antenatal corticosteroids did not significantly alter the neonatal pulmonary outcomes in late preterm infants.

Assessment of Neurodevelopmental Status and Risk Factors for Adverse Neurodevelopmental Outcome in Late Preterm Infants at 6 Months Corrected Age : An Prospective Observational Study

Background: Late Preterm (LP) infants, previously considered low risk, have been identified to be at risk of developmental problems in infancy and early childhood. There is limited information on the outcome of these infants in low and middle income countries. This study was aimed to assess the neurodevelopmental status of LP born neonates and to determine factors associated with adverse neurodevelopmental outcome in a tertiary hospital of Chattogram, Bangladesh.
 Materials and methods: In this prospective observational study, 108 LP (34 to <37 completed weeks gestation at birth) infants were enrolled from the Special Care Neonatal Unit (SCANU) Chittagong Medical College Hospital (CMCH) from June 2018 to May 2019. Neurodevelopmental assessment was done by Rapid Neurodevelopmental Assessment (RNDA) at 1, 3, and 6 months of Corrected Age (CA).
 Results: Of the 108 enrolled children, 30 (27.8%) attended all 3 follow-up, 69 (63.9%) had incomplete follow-up, and 9 (8.3%) died. At final follow-up, out of 30 infants, 25 (83.3%) had no abnormality in all 8 domains of RNDA. Three infants (10.0%) had abnormalities in one domain and 2 (6.7%) had abnormalities in 5 domains. Gross motor abnormality was most common abnormality (13.4%), followed by speech (10.0%), and cognition (6.7%). Small for gestational age was found to be the only independent predictive factor for Neurodevelopmental Abnormality (NDA) in LP infants.
 Conclusion: This study demonstrates that 16.7% of the LP infants had evidence of neurodevelopmental impairment at 6 months of corrected age. SGA was an important risk factor of adverse neurodevelopmental outcome. Thus, LP infants in Bangladesh require long-term follow-up to monitor developmental outcome.
 JCMCTA 2021 ; 32 (2) : 70-74

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.

Respiratory and glycemic control outcomes of late preterm infants after antenatal corticosteroid exposure.

To quantify changes in respiratory and glycemic control outcomes following antenatal corticosteroids (ANCS) exposure in late preterm neonates. The study included 500 neonates born between 34 0/7 and 36 6/7 weeks of gestation. Study population was divided into two groups: an immature group (34 0/7-35 6/7 weeks) and a mature group (36 0/7-36 6/7 weeks). Respiratory and glycemic control outcomes were analyzed for each group independently. In the immature group, the odds of developing respiratory distress decreased in neonates exposed to ANCS within 7 days of delivery (aOR 0.42; p = 0.02). In the mature group, ANCS exposure did not change respiratory outcomes, but decreased lowest blood glucose levels (-1.5 ± 0.66 mg/dL per dose, p = 0.02). In our study cohort, ANCS administration was associated with improved neonatal respiratory outcomes only for infants in the immature 34 0/7-35 6/7 weeks of gestational age group. ANCS was associated with altered glycemic control only in infants in the mature 36 0/7-36 6/7 weeks of gestational age group.

Neonatal Outcome of Late Preterm Infants Delivered in a Tertiary Care Hospital

Neonatal Outcome of Late Preterm Infants Delivered in a Tertiary Care Hospital

Cognitive and Learning Outcomes in Late Preterm Infants at School Age: A Systematic Review.

Late preterm children born between 340/7 and 366/7 weeks’ gestation account for ≈70% of prematurely born infants. There is growing concern about this population at risk of mild neurodevelopmental problems, learning disabilities and lower academic performance. Following the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statement, this paper analyzes recent published evidence from 16selected studies involving late preterm children and control group assessments at preschool and/or school age, mainly focusing on cognitive functioning, language learning and academic achievement. The review identifies the assessment tools used in these studies (standardized tests, parental questionnaires and laboratory tasks) and the areas being evaluated from preschool (age 3 years) to primary school levels. Results reveal the presence of mild difficulties, pointing to suboptimal outcomes in areas such as executive function, short term verbal memory, literacy skills, attention and processing speed. Some difficulties are transient, but others persist, possibly compromising academic achievement, as suggested by the few studies reporting on higher risk for poor school performance. Given the increasing number of late preterm children in our society the review highlights the need to implement screening strategies to facilitate early risk detection and minimize the negative effects of this morbidity in childhood.

Early Neurological Assessment and Long-Term Neuromotor Outcomes in Late Preterm Infants: A Critical Review.

Background and Objectives: Late preterm (LP) infants (born between 34 and 36 weeks of gestational age) are considered at higher risk of neonatal morbidities, mortality, and neurological impairments than full-term born infants (FT). The aim of this study was to provide a critical review of the literature outlining the different aspects of neurological function reported both in the neonatal period and in the follow up of late preterm infants. Materials and Methods: A comprehensive search of the MEDLINE, Embase, PsycINFO, and CINAHL electronic databases was made, using the following search terms: ‘Late preterm infants’, ‘Near term infants’, ‘neurological assessment’, ‘neurological outcome’, ‘neuromotor outcome’, cerebral palsy’, ‘CP’, ‘motor impairment’, including all the studies reporting clinical neurological assessment of LP (including both neonatal period and subsequent ages). Results: A total of 35 articles, comprising 301,495 children, were included as fulfilling the inclusion criteria: ten reported neonatal neurological findings, seven reported data about the first two years after birth, eighteen reported data about incidence of CP and motor disorder during the infancy. Results showed a more immature neurological profile, explored with structured neurological assessments, in LP infants compared with FT infants. The LP population also had a higher risk of developing cerebral palsy, motor delay, and coordination disorder. Conclusion: LP had a higher risk of neurological impairments than FT infants, due to a brain immaturity and an increased vulnerability to injury, as the last weeks of gestational age are crucial for the development of the brain.

Comparison of Clinical Outcomes in Late Preterm Infants between Born at 34+0 to 34+6 Weeks and at 35+0 to 36+6 Weeks of Gestation

Comparison of Clinical Outcomes in Late Preterm Infants between Born at 34+0 to 34+6 Weeks and at 35+0 to 36+6 Weeks of Gestation

Respiratory outcomes of late preterm infants of mothers with early and late onset preeclampsia

ObjectiveTo study the effect of early and late onset preeclampsia (EOPE, LOPE, respectively) on outcomes of late preterm infants.Study designCohort study of late preterm infants admitted to a tertiary care NICU from January 2014–July 2015. Outcomes of late preterm infants of EOPE mothers were compared with the next late preterm infant of a LOPE mother and the next two late preterm infants of normotensive non-PE mothers. Primary outcome comprised use of continuous positive airway pressure, mechanical ventilation and/or surfactant in the 24 h after birth.ResultsCompared to normotensives (n = 131), adjusted odds ratio (AORs) of the primary outcome was higher in the EOPE (n = 64) and LOPE (n = 65) groups but reached statistical significance only in the EOPE group, AORs 12.9, 95% CI 3.5–37 and 2.7, 95% CI 0.95–8.1, respectively.ConclusionsCompared to late preterm infants of normotensive and LOPE mothers, infants of mothers with EOPE have significantly higher respiratory morbidity.

Short-Term Outcomes following Standardized Admission of Late Preterm Infants to Family-Centered Care.

The study compares the short-term outcomes of late preterm infants (LPI) at an academic center in San Diego, California after a change in protocol that eliminated a previously mandatory 12-hour neonatal intensive care unit (NICU) observation period after birth. This is a retrospective observational study examining all LPI born with gestational age 35 to 366/7 weeks between October 1, 2016 and October 31, 2017. A total of 189 infants were included in the review. Short-term outcomes were analyzed before and after the protocol change. Transfers to the NICU from family-centered care (FCC) were considerably higher (23.2%) following the protocol change, compared to before (8.2%). More infants were transferred to the NICU for failed car seat tests postprotocol compared to preprotocol. Length of stay before the protocol change was 5.13 days compared to 4.80 days after. LPI are vulnerable to morbidities after delivery and through discharge. We found an increase in failed car seat tests in LPI cared for in FCC after elimination of a mandatory NICU observation after birth. The transitions of care from delivery to discharge are key checkpoints in minimizing complications.

A study on the neurodevelopment outcomes of late preterm infants

BackgroundThe study is intended to fill the knowledge gap about the neuropsychology and neuromotor developmental outcomes, and identify the perinatal risk factors for late preterm infants (LPIs 34~36 weeks GA) born with uncomplicated vaginal birth at the age of 24 to 30 months.MethodsThe parents/guardians of 102 late preterm infants and 153 term infants, from 14 community health centers participated in this study. The Modified Checklist for Autism in Toddlers (M-CHAT) questionnaire, the Chinese version of Gesell Development Diagnosis Scale (GDDS), and the Sensory Integration Schedule (SIS), a neurological examination for motor disorders (MD) were carried out. Infants screening positive to the M-CHAT were referred to specialist autism clinics.ResultsForty-six LPIs (45.1%) scored low in GDDS. Nine LPIs (8.8%) scored positive on M-Chat. 8.8% of LPIs (9 out of 102) were diagnosed MD (p < 0.05). Compared with their full-term peers, LPIs had statistically lower scores in GDDS and the Child Sensory Integration Checklist. LPIs who had positive results on M-CHAT showed unbalanced abilities in every part of GDDS. Risk factors of twin pregnancies, pregnancy induced hypertension and premature rupture of membranes had negative correlation with GDDS (all p < 0.05). Birth weight and gestational age were positively correlated with GDDS.ConclusionsLPIs shall be given special attention as compared to normal deliveries, as they are at increased risk of neurodevelopment impairment, despite being born with no major problems. Some perinatal factors such as twin pregnancies, and pregnancy induced hypertension etc. have negative effects on their neurodevelopment. Regular neurodevelopmental follow- up and early intervention can benefit their long term outcomes.

Neurodevelopmental outcome of late-preterm infants: A pragmatic review

The number of late-preterm births (34^{0/7} to 36^{6/7} weeks of gestation at birth) has steadily increased over recent years. Recent reports suggest that late-preterm infants are at an increased risk of developing neurodevelopmental abnormalities, compared with full-term infants. The aim of this paper is to carry out a pragmatic review of the current evidence regarding the neurodevelopmental risks of speech delay, cerebral palsy, cognitive delay, autism spectrum disorder and attention deficit hyperactivity disorder in late-preterm infants. Evidence from cohort studies indicates that late-preterm infants have a higher risk of speech delay in the first two years, and cognitive delay and attention problems in early childhood, compared with infants born at term. However, the results are inconsistent. Some reports indicate ‘catch up’ development with speech and cognition. Developmental surveillance through regular follow-up of high-risk late-preterm infants is necessary to identify risks at the earliest.

Neurodevelopmental outcome of late preterm infants in Johannesburg, South Africa

BackgroundLate preterm infants, previously considered low risk, have been identified to be at risk of developmental problems in infancy and early childhood. There is limited information on the outcome of these infants in low and middle income countries.MethodsBayley scales of infant and toddler development, version III, were done on a group of late preterm infants in Johannesburg, South Africa. The mean composite cognitive, language and motor sub-scales were compared to those obtained from a group of typically developed control infants. Infants were considered to be “at risk” if the composite subscale score was below 85 and “disabled” if the composite subscale score was below 70. Infants identified with cerebral palsy were also reported.Results56 of 73 (76.7%) late preterm infants enrolled in the study had at least one Bayley assessment at a mean age of 16.5 months (95% CI 15.2–17.6). The mean birth weight was 1.9 kg (95%CI 1.8–2.0) and mean gestational age 33.0 weeks (95% CI 32.56–33.51). There was no difference in the mean cognitive subscales between late preterm infants and controls (95.4 9, 95% CI 91.2–99.5 vs 91.9.95% CI 87.7–96.0). There was similarly no difference in mean language subscales (94.5, 95% CI 91.3–97.7 vs 95.9, 95% CI 92.9–99.0) or motor subscales (96.2, 95% CI 91.8–100.7 vs 97.6, 95% CI 94.7–100.5). There were four late preterm infants who were classified as disabled, two of whom had cerebral palsy. None of the control group was disabled.ConclusionsThis study demonstrates that overall developmental outcome, as assessed by the Bayley scales of infant and toddler development, was not different between late preterm infants and a group of normal controls. However, 7.1% of the late preterm infants, had evidence of developmental disability. Thus late preterm infants in low and middle income countries require long term follow up to monitor developmental outcome. In a resource limited setting, this may best be achieved by including a parental screening questionnaire, such as the Ages and Stages Questionnaire, in the routine well baby clinic visits.