Outcomes Of Late Preterm Infants Research Articles

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.

Neurodevelopmental and emotional-behavioral outcomes in late-preterm infants: an observational descriptive case study

BackgroundOver the last decade, several studies investigated the outcomes in children born very preterm. Only recently there has been an increasing interest in the late preterm infants (born between 34 + 0 and 36 + 6 weeks). This population is at high risk of morbidity and mortality in the first years of life. Other studies reported that they are also at risk of long-term developmental problem. Therefore, the aim of this study is to describe the neurodevelopmental and emotional-behavioral outcome in a sample of late preterm patients.MethodsThe study included late preterm children and adolescents who had neuropsychiatric and/or neurological symptoms. They underwent a general, neurocognitive and an emotional-behavioral assessment. Exclusion criteria included: patients affected by Central Nervous System congenital abnormalities, neurodegenerative diseases, genetic disorders, epilepsy, or in pharmacological treatment, or adopted children. A descriptive statistics analysis was performed to describe the sociodemographic and clinical characteristics of patients. Risk factors related to late preterm birth, prevalence of neurodevelopmental disorders, and cognitive functioning were recorded and analyzed.ResultsThe sample included 68 LPI (45 males and 23 females) aged from 2 to 16.3 years (mean age 7,5 years), who were affected by one or more neurodevelopmental disorder, including Language Disorder, Attention Deficit Hyperactivity Disorder, Specific Learning Disorder, Developmental Coordination Disorder, Intellectual Disability and Autism Spectrum Disorder. Moreover, in 30.8% of patients, internalizing problems (affective and social skills problem) were detected.ConclusionsOur results support the importance of a long-term surveillance of late preterm and the great need for more longitudinal large population studies in order to collect data on the neurodevelopmental outcomes of this population.

592: Adverse outcomes of late preterm infants according to route of delivery

To evaluate adverse outcomes of late preterm neonates according to route of delivery. Secondary analysis of a multicenter randomized controlled trial of women with singleton pregnancies 34 0/7 - 36 5/7 weeks’ gestation at high risk for preterm birth who were randomized to receive antenatal corticosteroids or placebo. We included all women who delivered <37 weeks’ gestation and excluded those whose neonates were diagnosed with a major anomaly postnatally. The primary outcome was a composite of the need for respiratory support (CPAP or HFNC ≥2 consecutive hours, supplemental O2 with an FiO2 ≥0.30 for ≥4 continuous hours, mechanical ventilation, or the need for ECMO), stillbirth or neonatal death ≤72 hours after birth. Secondary outcomes were a composite of severe neonatal morbidity, including mechanical ventilation, RDS, BPD, sepsis, NEC, and grade II, III, or IV IVH or cystic PVL; severe respiratory complication (CPAP or HFNC ≥12 hours, supplemental O2 with an FiO2 ≥0.30 for ≥24 hours, mechanical ventilation, stillbirth or neonatal death, or the need for ECMO); NICU length of stay ≥3 days; feeding difficulty; and hypothermia. Demographic and antenatal characteristics were compared using chi-square, Mann-Whitney U, or t-test, as appropriate. Multivariable logistic regression models estimated ORs for the primary and secondary outcomes. 2329 (82.3%) of 2831 randomized subjects met inclusion criteria; 1546 (66.3%) delivered vaginally and 783 (33.6%) delivered by cesarean. Table 1 compares antenatal characteristics between the groups. Women who delivered by cesarean were older, had a higher BMI, and were more likely to have a medical indication for late preterm birth. In adjusted models (Table 2), cesarean delivery was associated with higher odds of the primary outcome (aOR 1.79, 95% CI 1.35 - 2.36), composite severe neonatal morbidity (aOR 1.62, 95% CI 1.16 - 2.27), severe respiratory complication, feeding difficulty, and NICU stay ≥3 days (aOR 1.62, 95% CI 1.29 - 2.03). Among late preterm neonates, cesarean delivery is associated with higher odds of respiratory or other neonatal morbidity, and prolonged NICU length of stay, when compared with vaginal delivery. While confounding by indication for delivery remains a limitation of this study, when feasible, efforts should be made to promote vaginal delivery in women at risk for late preterm birth.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Short-term neonatal outcome in late preterm vs. term infants.

To determine the short-term neonatal outcomes in late preterm infants (LPI's) as compared to term infants and their association with maternal risk factors. A case control, descriptive study. The Aga Khan University Hospital, Karachi, Pakistan, from January to December 2009. The study included 326 late preterm babies (defined as those born between 340⁄7 to 376⁄7 weeks of gestation) and equal number of term control babies at the Aga Khan University Hospital, Karachi, Pakistan. Data, including obstetric history, maternal complications, neonatal morbidities, etc., was retrieved from patients' medical records. The data was compared with the control group for complications, fetal morbidity and maternal morbidity. Late preterm infants constituted 10.6% of all deliveries and 77% of all live preterm births during the study period. Respiratory distress syndrome (RDS) (16.5% vs. 0.3%, p < 0.001), growth retardation (24.8% vs. 4%, p < 0.001), hyperbilirubinemia requiring phototherapy (37.9% vs. 11%, p < 0.001), and sepsis (4.9% vs. 0.3%, p < 0.001) were found to be the major morbidities in the study group. The need for resuscitation was 12.7 times higher in the study group as compared to the term babies (21.4% vs. 1.2%, p < 0.001). NICU admissions in the study group were also higher (18.8% vs. 2.4%, p < 0.001). Hypertension (12.5% vs. 1.5%, p < 0.001), diabetes (12.5% vs. 9.2%, p < 0.001), antenatal history of UTI (1.5% vs. 0.3%, p < 0.001), and prolong rupture of membrane (8.9% vs. 4%, p < 0.001) were significant maternal morbidities in the late preterm group. The late preterm group had greater morbidity, compared to term neonates. Prior awareness of the morbidities associated with late preterm babies is helpful for the health care providers to anticipate and manage potential complications in late preterm infants.

A Randomized Controlled Trial to Evaluate the Role of Brief Delay in Cord Clamping in Preterm Neonates (34–36 weeks) on Short-term Neurobehavioural Outcome

To study the effect of brief delay in cord clamping on short-term neurobehavioural outcome of preterm neonates. All preterm neonates born between 34-36 weeks and 6 days were included and randomized into either a control or intervention group. In the control group, clamping was done within 20 s after delivery, and this was termed as immediate cord clamping (ICC). In the intervention group, delayed cord clamping (DCC) took place between 30 and 60 s. A total of 120 preterm neonates were enrolled. The primary outcome studied was short-term neurobehavioural outcome at 37 weeks after conceptional age using the Neurobehavioral Assessment of Preterm Infants (NAPI) score as the outcome measure. NAPI scores at 37 weeks of corrected gestational age revealed a mean (95% confidence interval) score of motor development and vigour of 64.21±27.31 (57.27 - 71.14) vs. 76.69±25.29 (70.04-83.34), p= 0.01; and alertness and orientation of 29.31±12.78 (26.06-32.55) vs. 42.77±15.75 (38.63-46.91), p= 0.00 across the ICC vs. DCC groups, respectively. A brief delay of 30-60 s in cord clamping is beneficial in improving neurobehavioural outcome of late preterm infants.

Association between maternal pre-pregnancy body mass index and adverse outcomes of late preterm infants

To study the association between maternal pre-pregnancy body mass index (BMI) and adverse outcomes of late preterm infants (LPI). A total of 367 LPI who were born from January 2011 to December 2015 and admitted to the neonatal ward were enrolled. The BMI criteria for Chinese population were used to analyze the factors for maternal pre-pregnancy BMI and its association with adverse outcomes of LPI (1 minute Apgar score ≤7, delivery room resuscitation, hospitalization days after birth >7 days, and ventilation duration ≥6 hours). Of all LPIs, there were 64 LPI (17.4%) in the low maternal pre-pregnancy BMI group, 243 LPI (66.2%) in the normal maternal pre-pregnancy BMI group, and 60 LPI (16.4%) in the high maternal pre-pregnancy BMI group. Low pre-pregnancy BMI was the risk factor for 1 minute Apgar score ≤7 (OR=3.243, 95% CI: 1.102-9.546) and need for delivery room resuscitation (OR=3.492, 95%CI: 1.090-11.190), and high pre-pregnancy BMI was the risk factor for hospitalization days after birth >7 days (OR=1.992, 95%CI: 1.024-3.874). Abnormal maternal pre-pregnancy BMI has adverse effects on the outcomes of LPI. In order to reduce these adverse outcomes BMI should be controlled within the normal range in pregnant women.

Facilitators and barriers of breastfeeding late preterm infants according to mothers' experiences.

BackgroundLate preterm infants account for the majority of preterm births. They are at an increased risk of neonatal mortality and morbidity and are less likely to initiate breastfeeding and to be exclusively breastfed at discharge compared to infants born at term. The aim of this study was to identify the facilitators and barriers to breastfeeding during hospital stays according to the experiences of mothers of late preterm infants.MethodsWe conducted a cross-sectional questionnaire survey. Mothers who intended to breastfeed and had given birth to a newborn admitted to level I and II care, with a gestational age of 34 0/7 to 36 6/7 weeks, were enrolled. Sociodemographic data, neonatal variables, mode of feeding and feeding status at discharge were also collected.ResultsA total of 92 mothers who had given birth to 121 infants were enrolled. At discharge, any human milk was fed to 94 % of infants, with exclusively human milk being fed in 43 % of cases; exclusively formula was fed to 6 % of infants. In the multivariate analysis, having expressed breast milk was independently associated with an increased risk of being fed with either any human milk or formula only (OR = 2.73, 95 % CI 1.05–7.1, p = 0.039), whereas being encouraged to practice kangaroo mother care tended to have a protective effect (OR = 0.46, 95 % CI 0.2–1.06, p = 0.07).ConclusionsBased on the present findings, health care professionals should strive to fully implement breastfeeding support for mothers of late preterm infants who intend to breastfeed, in particular optimizing breast milk expression and promoting kangaroo mother care. Further studies are needed to gain further insight into the complex interplay of the factors that modulate breastfeeding outcome in late preterm infants.

Developmental Outcomes of Late Preterm Infants From Infancy to Kindergarten.

To compare developmental outcomes of late preterm infants (34-36 weeks' gestation) with infants born at early term (37-38 weeks' gestation) and term (39-41 weeks' gestation), from infancy through kindergarten. Sample included 1000 late preterm, 1800 early term, and 3200 term infants ascertained from the Early Childhood Longitudinal Study, Birth Cohort. Direct assessments of development were performed at 9 and 24 months by using the Bayley Short Form-Research Edition T-scores and at preschool and kindergarten using the Early Childhood Longitudinal Study, Birth Cohort reading and mathematics θ scores. Maternal and infant characteristics were obtained from birth certificate data and parent questionnaires. After controlling for covariates, we compared mean developmental outcomes between late preterm and full-term groups in serial cross-sectional analyses at each timepoint using multilinear regression, with pairwise comparisons testing for group differences by gestational age categories. With covariates controlled at all timepoints, at 9 months late preterm infants demonstrated less optimal developmental outcomes (T = 47.31) compared with infants born early term (T = 49.12) and term (T = 50.09) (P < .0001). This association was not seen at 24 months, (P = .66) but reemerged at preschool. Late preterm infants demonstrated less optimal scores in preschool reading (P = .0006), preschool mathematics (P = .0014), and kindergarten reading (P = .0007) compared with infants born at term gestation. Although late preterm infants demonstrate comparable developmental outcomes to full-term infants (early term and full-term gestation) at 24 months, they demonstrate less optimal reading outcomes at preschool and kindergarten timepoints. Ongoing developmental surveillance for late preterm infants is warranted into preschool and kindergarten.

Outcome of Late Preterm Infants at the University Hospital of the West Indies.

Objective The objective of this study was to determine the outcome of late preterm infants at the University Hospital of the West Indies (UHWI) over a 2-year period. Design and Methods A retrospective, descriptive, case-controlled study was performed. Data were extracted from the maternal and neonatal medical records of 163 late preterm infants and matched term controls. Descriptive analyses were performed comparing morbidity and mortality between the groups. Results There was an overall incidence of 3.8% late preterm births. Late preterm infants were more likely to require admission to the neonatal unit than term controls (odds ratio:13.6; confidence interval: 7.95-23.34; p < 0.001) and they had a longer mean duration of stay (p < 0.05). During admission, late preterm infants had a significantly higher incidence of hypothermia, neonatal jaundice, and need for respiratory support than term controls (p < 0.05). There, however, was no increased risk of mortality. Mothers of late preterm infants had a higher incidence of hypertension in pregnancy, prolonged rupture of membranes (p < 0.001), and operative delivery than mothers of term controls (p < 0.05). Conclusion Late preterm infants at the UHWI were shown to be at increased risk of morbidity. This finding has implications for antenatal care, timing of delivery, and monitoring of these infants postdelivery.

Long-term neurodevelopmental outcomes of infants born late preterm: a systematic review

Long-term neurodevelopmental outcomes of infants born late preterm: a systematic review Tanya Tripathi,1 Stacey C Dusing2,3 1Rehabilitation and Movement Science Program, Department of Physical Therapy, 2Department of Physical Therapy, 3Department of Pediatrics, Children&#39;s Hospital of Richmond, Virginia Commonwealth University, Richmond, VA, USA Purpose: Late preterm (LPT) births constitute a large proportion of the preterm births in the USA. Over the last few decades, there has been an increase in research focusing on the neurodevelopment of infants born LPT. The purpose of this research was to systematically review the long-term neurodevelopmental outcomes in LPT infants. Materials and methods: We identified studies by using PubMed, ERIC, CINAHL, and PsycINFO databases. The references of included papers were reviewed for additional papers that met the inclusion criteria. Included papers compared motor, cognitive, language development, or academic performance outcomes between individuals born LPT and a term control group assessed between 12 months and 18 years of age. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards for systematic reviews were utilized including a two-step, two-investigator review process. Results: Of the 4,720 studies found in the initial search, 20 studies met the inclusion criteria. Approximately 75% of the 16 studies that assessed cognitive outcomes reported cognitive delay in the LPT group when compared to their full-term counterparts. More than 50% of the seven studies that assessed motor outcomes suggested a delay in motor development in the LPT group in comparison to full-term. Fewer papers assessed academic performance and language in children born LPT; however, the majority identified borderline differences when LPT infants were compared to those born full-term. Conclusion: Evidence suggests that infants born LPT are at an increased risk of neurodevelopmental delay between 1 and 18 years of life when compared to those born at term. The delay is most evident in the cognitive domain of neurodevelopment. Children born LPT are also at a risk of delayed language development, motor development, and lower academic performance. The rate of developmental delay is reduced somewhat when controlling for social factors; however, group differences persist. Keywords: late preterm infants, developmental outcomes, motor development, cognitive development, language development and school performance

Impact of Respiratory Morbidities on Neurodevelopmental Outcome of Late Preterm Infants.

This study aims to evaluate impact of respiratory and other neonatal comorbidities on neurodevelopmental outcome in late preterm infants (LPT). Retrospective study of LPT infants (34 (0/7)-36 (6/7) weeks' gestation) discharged from the New York University Langone Medical Center neonatal intensive care unit, during January 2006 to December 2010 and received follow-up care up to 2 years of age. Neonatal morbidities were correlated with neurodevelopmental outcomes and assessed by performance on the Mullen Scales of Early Learning during three developmental follow-up visits. A total of 99 LPT completed neurodevelopmental assessment up to 2 years of age. Infants with diagnosis of moderate-to-severe respiratory distress syndrome showed a significantly lower performance in the visual reception on the second (p<0.01) and third visit (p=0.02), as well as lower performance in the receptive language (visit 2, p=0.02; visit 3, p<0.01). A diagnosis of persistent pulmonary hypertension was found to be associated with significantly lower performance in the visual reception at all visits (p<0.01; p=0.02; p=0.02) and in the receptive language on the second and third visit (p=0.03; p=0.02). Combined respiratory morbidities were also associated with lower developmental scores in fine motor (visit 2, p<0.01; visit 3, p=0.04) as well as expressive language (visit 3, p=0.02). LPT with significant respiratory morbidities are at higher risk for long-term developmental delays, mainly affecting cognitive developmental domains.

Neurodevelopmental outcome at 18 months of late preterm infants

Objective To study the neurodevelopmental outcome prospectively at 18 months of the late preterm infants. Methods Data from 7 584 live born neonates were collected between January and December.2009 in 3 hospitals located in the north of Chengdu City, Sichuan Province were collected, 89 late preterm infants were brought into study; 170 healthy full-term infants were chosen as the controls randomly.Neurodevelopment outcome was assessed by using neonatal behavioral neurological assessment(NBNA) at 40 weeks corrected gestational age, and Bayley scales of infant development was performed to obtain the physical development index(PDI)and mental development index(MDI) at 3, 6, 9, 12 and 18 months corrected age.Neurodevelopmental outcome of late preterm infants was studied compared with that of the term infants. Results Sixty-three neonates born at the late preterm phase and 115 neonates born at the term phase were successfully followed up.The NBNA scores of the late preterm infants at 40 weeks corrected gestational age were significantly lower than those of the term infants.The proportion of the late preterm infants whose scores ≥37 was significantly lower than that of the term infants(82.5% vs 94.8%), the proportion of late preterm infants whose scores 0.05). Conclusions Neurodevelopment outcome of the late preterm infants is delayed in the first year compared with term infants.At 18 months corrected age the mental development is still delayed compared with the term infants.Measures should be taken properly to improve the neurodevelopment of the late preterm infants in the early childhood. Key words: Late preterm infant; Neurodevelopment; Neonatal behavioral neurological assessment; Bayley scales of infant development

Neurodevelopmental Outcome of Late Preterm Infants at 12 Months of Age

Background: Late-preterm infants (34-36+6 weeks’ gestation) are often believed to have no higher risks for morbidity and mortality than term infants. This study aims to evaluate the neurodevelopmental outcome of late preterm infants at 12 months of age, compared to term infants. Methods: Neurodevelopmental assessment was administered using the Bayley Scale of Infant Development. Eighty participants, including 40 late preterm and 40 term infants were included. Results: At 12 months of age, the neurodevelopmental assessments of late preterm infants adjusted for prematurity showed no difference from those of term infants. However, without adjusting for prematurity, late preterm infants had a significantly lower Mental Developmental Index and Psychomotor Developmental Index scores than term infants. Conclusion: The findings in this study reveal that late preterm infants had not completed their developmental maturation at 12 months of age. Monitoring these children may help in the early identification of developmental problems and provide appropriate intervention.

The Impact of Surgery on the Developmental Status of Late Preterm Infants – A Cohort Study

Aims: Despite increasing evidence in the literature regarding the impact of late prematurity on subsequent developmental impairment, the developmental outcome of late preterm infants who undergo major surgery remains unclear. The aim of this study therefore was to determine the developmental outcome for a cohort of late preterm surgical population.Methods: Late preterm infants with a gestational age from 34-36 weeks inclusive who were enrolled in the state-wide prospective Development After Infant Surgery (DAISy) study and who had undergone non-cardiac major surgery within the first ninety days of life were eligible for inclusion. Infants were assessed at one and three years of ages.Results: Forty-six infants were enrolled in the study, of which 38 infants had a complete developmental assessment at one year of age. Of these infants, late preterm infants scored significantly lower than the standardized norms of the assessment on the expressive language and gross motor subscales. At three years of age 26 infants were reassessed: late preterm infants who underwent major surgery only scored significantly lower than the standardized norms on the cognitive subscale (p&lt;0.001).Conclusions: These data provide the evidence that late preterm infants who undergo major non-cardiac surgery are at risk of developmental impairment and consideration should be given to enrolling this cohort in multi-disciplinary developmental follow-up clinics.

The impact of surgery on the developmental status of late preterm infants - a cohort study.

Despite increasing evidence in the literature regarding the impact of late prematurity on subsequent developmental impairment, the developmental outcome of late preterm infants who undergo major surgery remains unclear. The aim of this study therefore was to determine the developmental outcome for a cohort of late preterm surgical population. Late preterm infants with a gestational age from 34-36 weeks inclusive who were enrolled in the state-wide prospective Development After Infant Surgery (DAISy) study and who had undergone non-cardiac major surgery within the first ninety days of life were eligible for inclusion. Infants were assessed at one and three years of ages. Forty-six infants were enrolled in the study, of which 38 infants had a complete developmental assessment at one year of age. Of these infants, late preterm infants scored significantly lower than the standardized norms of the assessment on the expressive language and gross motor subscales. At three years of age 26 infants were reassessed: late preterm infants who underwent major surgery only scored significantly lower than the standardized norms on the cognitive subscale (p less than 0.001). These data provide the evidence that late preterm infants who undergo major non-cardiac surgery are at risk of developmental impairment and consideration should be given to enrolling this cohort in multi-disciplinary developmental follow-up clinics.

Cranial ultrasound screening in late preterm infants

Late preterm births have enormously increased in the last decades and there is mounting evidence showing that infants born late preterm are less healthy than infants born at term [1] and they are more likely to develop neonatal morbidities (temperature instability, respiratory distress syndrome, excessive weight loss and dehydration requiring intravenous infusion, sepsis, hypoglycemia and jaundice requiring phototherapy) [2]. More recently, an increased neuromorbidity has been documented and long-term neurodevelopmental impairments (poor school performance, early intervention services, special education needs) have been reported in this population [3,4]. The neuromorbidity of the late preterm infants has been attributed to both the potential detrimental neurological effects (extrinsic vulnerability) of the morbidities these babies experience in the neonatal period, and to the intrinsic brain vulnerability. Advances in neuroimaging techniques have highlighted a higher intrinsic vulnerability of the late preterm brain due to the structural and molecular immaturity of the developing brain at specific gestational ages [5,6]. Therefore, late preterm infants have a risk to develop brain lesions which is lower than more premature babies but higher than term newborns and they can be affected by brain lesions common to both preterm and term infants [7]. However, the incidence of brain abnormalities in this specific population has never been investigated as late preterm infants have long been considered a large and low-risk population. Considering that most of the brain lesions are clinically subtle or silent during the neonatal period, a cranial ultrasound screening may play a role in: 1. detecting babies at risk of impaired neurodevelopment later in childhood and who may benefit from early intervention programs; 2. identifying the most significant perinatal risk factors associated with brain abnormalities in such a large low-risk population in order to target the potential need for cranial ultrasound at birth. Based on these assumptions we performed a cranial ultrasound screening project on late preterm infants. Our preliminary data (unpublished data) suggest that lower gestational age, within the late preterm period, and early neonatal morbidities, can provide an indication at birth to undergo a cranial ultrasound scan as they are associated with a higher risk to develop brain abnormalities. Late preterm infants represent a vulnerable population and investigation and follow-up program should be modulated according to the prenatal, perinatal and postnatal characteristics. Follow-up studies are needed to correlate neonatal ultrasound findings with long-term neurobehavioral outcomes in late preterm infants.

Follow-up of late preterm infants: why, what and who?

Late preterm infants (LPI) represent a growing population with own peculiar vulnerabilities; only recently attention has been focused on the impact of late preterm birth on child health, in order to define short and long-term outcomes [1,2]. LPI are physiologically and metabolically immature; they are at higher risk than term infants of developing medical complications, resulting in greater rate of mortality and morbidity not only in the neonatal period, but also during infancy, childhood, adolescence, and through adulthood [2,3]. Increasing evidence shows the association between late-preterm birth and various long-term medical and behavioral morbidities, including cerebral palsy, attention problems and antisocial behavior, as well as lower IQ, impaired cognitive and academic performance at school age. Fetal brain undergoes a dramatic growth and maturation during last four weeks of gestation, and this is probably the most important reason of LPI worse neurodevelopmental outcomes compared to full-term infants [3-5]. Physical development is an other important outcome for LPI; in addition to intrauterine growth restriction, LPI may be susceptible to feeding difficulty resulting in poor weight gain and underweight. Since failure to thrive in early infancy may be also associated with adverse cognitive and developmental outcomes, close monitoring of LPI growth pattern is needed [6]. Moreover, late-preterm birth has a negative effect also on maturation of the lungs, interrupting evolution from alveolar saccules to mature alveoli. LPI have been shown to develop early respiratory morbidities more frequently than infants born at term. However, the risk for long-term respiratory problems, such as asthma, has not yet been established in this group of patients [3,7]. Therefore LPI need a multidisciplinary, personalized and effective follow–up care that begins at birth and continues, with varying degrees of surveillance and reflecting individual needs, throughout the lifespan. Pediatricians must play a crucial role by ensuring that appropriate screening and assessments are completed, referrals are made and continuity of care is coordinated. They have to be aware of the major problems that LPI may encounter, providing anticipatory guidance when needed. Pediatricians together with parents, child development specialists, and education professionals need to know the possible school underachievement and behavioral problems so that prompt referrals to early intervention services are made [8,9]. Up to now, standardized short and long term followup schedule for LPI has not been developed yet; therefore, further research should focus on systematic evaluation of outcomes of LPI, in order to optimize follow-up monitoring of this population of children.

A Comparison of the Short-term Morbidity and Mortality Between Late Preterm and Term Newborns

Late preterm babies are defined as those born between 34 to 36 completed weeks. There has been a recent increased awareness that this group of babies has a higher incidence of morbidity as compared to term babies. The aim of this study was to evaluate the short-term morbidities occurring in this group of babies managed in the neonatal unit at Singapore General Hospital (SGH). A retrospective study was done of babies managed in the neonatal unit at SGH from January 2005 to December 2008. Maternal, perinatal and neonatal data were obtained from the departmental database. The outcomes of late preterm infants were compared with term infants. A total of 6826 babies were admitted. Ten percent (681 out of 6826) of babies were late preterm babies, making up 63% (681 out of 1081) of all preterm babies. Late preterm babies had significantly greater need for resuscitation at birth. They also had statistically significant increased risks of developing hyaline membrane disease (2.5% vs 0.1%), transient tachypnoea of the newborn (TTN) (8.1% vs 1.7%), pneumonia (7.0% vs 2.8%), patent ductus arteriosus (PDA) (4.3% vs 1.1%), hypotension (0.7% vs 0%), apnoea (3.7% vs 0%), gastrointestinal (GI) bleeding (1.5% vs 0.3%), polycythaemia (2.2% vs 1.0%), anaemia (3.4% vs 1.2%), thrombocytopenia (3.2% vs 0.6%), hypoglycaemia (6.6% vs 1.7%), neonatal jaundice requiring phototherapy (41.1% vs 12.2%) and sepsis (1.7% vs 0.6%). Late preterm infants are indeed a vulnerable group of infants with significant morbidities that need to be addressed and treated. Despite their relatively large size and being almost term, the understanding that late preterm infants are not similar to term infants is important to both obstetricians and neonatologists.

Short-term respiratory outcomes in late preterm infants.

ObjectiveTo evaluate short-term respiratory outcomes in late preterm infants (LPI) compared with those of term infants (TI).MethodsA retrospective study conducted in a single third level Italian centre (2005–2009) to analyse the incidence and risk factors of composite respiratory morbidity (CRM), the need for adjunctive therapies (surfactant therapy, inhaled nitric oxide, pleural drainage), the highest level of respiratory support (mechanical ventilation – MV, nasal continuous positive airway pressure – N-CPAP, nasal oxygen) and the duration of pressure support (hours in N-CPAP and/or MV).ResultsDuring the study period 14,515 infants were delivered. There were 856 (5.9%) LPI and 12,948 (89.2%) TI. CRM affected 105 LPI (12.4%), and 121 TI (0.9%), with an overall rate of 1.6%. Eighty-four LPI (9.8%) and 73 TI (0.56%) received respiratory support, of which 13 LPI (1.5%) and 16 TI (0.12%) were ventilated. The adjusted OR for developing CRM significantly increased from 3.3 (95% CI 2.0-5.5) at 37 weeks to 40.8 (95% CI 19.7-84.9%) at 34 weeks. The adjusted OR for the need of MV significantly increased from 3.4 (95% CI 1.2-10) at 37 weeks to 34.4 (95% CI 6.7-180.6%) at 34 weeks. Median duration of pressure support was significantly higher at 37 weeks (66.6 h vs 40.5 h). Twin pregnancies were related to a higher risk of CRM (OR 4.3, 95% CI 2.6-7.3), but not independent of gestational age (GA). Cesarean section (CS) was associated with higher risk of CRM independently of GA, but the OR was lower in CS with labour (2.2, 95% CI 1.4-3.4 vs 3.0, 95% CI 2.1-4.2).ConclusionsIn this single third level care study late preterm births, pulmonary diseases and supportive respiratory interventions were lower than previously documented. LPI are at a higher risk of developing pulmonary disease than TI. Infants born from elective cesarean sections, late preterm twins in particular and 37 weekers too might benefit from preventive intervention.

Maternal risk factors and obstetric complications in late preterm prematurity

ObjectiveLate preterm prematurity has been related to poorer neonatal outcomes. However, research has focused on the neonatal outcomes of late preterm infants, maternal characteristics of these births have been less evaluated. The aim of the study was to compare maternal risk factors and obstetric complications in late preterm births (LPTB) and term births. These factors were also assessed comparing spontaneous LPTB with medically-indicated LPTB. Study designWe conducted a retrospective cohort study with two groups. All singleton LPTB occurred at our University Hospital between January 1, 2009 and December 31, 2010 were included in the first cohort (n=171). A comparison cohort of term births was configured in a ratio 2:1 (n=342). Well-dated pregnancies without congenital malformations, congenital infections or chromosome abnormalities were eligible. LPTB were classified into two groups, spontaneous LPTB and medically-indicated LPTB following delivery indications. Statistical analysis of categorical variables was performed using either χ2 or Fisher’s exact. Continuous variables were compared using the Student’s t-test. ResultsWomen with LPTB had more medical conditions than women with term births (29% vs 15.7%; P=0.002). Prior preterm births (9.7% vs 2%; P<0.001), prior adverse obstetric outcomes (6.9% vs 2.3%; P<0.001), and obstetric complications were also more frequent in LPTB than in term births. However, no differences were found in maternal medical conditions when spontaneous LPTB and medically-indicated LPTB were compared. Women with medically-indicated LPTB were older (33.69 vs 31.07; P=0.003) and mainly nulliparous (75.8% vs 49.4%; P=0.002). Obstetric complications were more frequent in medically-indicated LPTB than in spontaneous LPTB. ConclusionsMaternal risk factors and obstetric complications are significantly higher in LPTB than in term births. These factors should be considered to identify women at risk for either spontaneous or medically-indicated LPTB.