Risk Of Neonatal Respiratory Morbidity Research Articles

Neonatal Respiratory Morbidity after Late Preterm, Singleton, Cesarean Delivery before Labor by Mothers Who Did Not Receive Antenatal Corticosteroids.

Some evidence suggests that administration of antenatal corticosteroids (ACS) reduces neonatal respiratory complications among women at risk for late preterm birth. However, because of concerns regarding long-term outcomes of children, ACS is not recommended in Japan for pregnant women at risk in late preterm. We assessed the risk of neonatal respiratory morbidity after late preterm, singleton, cesarean delivery before labor by mothers who did not receive ACS. We retrospectively reviewed and analyzed data on singleton cesarean deliveries of late preterm infants. The prevalence of neonatal respiratory morbidity requiring ventilatory support, such as continuous positive airway pressure or mechanical ventilation, was analyzed in relation to gestational age in late preterm. Respiratory distress syndrome (RDS) in neonates was also evaluated. We analyzed data from 100 late preterm, singleton, cesarean deliveries: 22 neonates were delivered at 34 weeks, 34 at 35 weeks, and 44 at 36 weeks. Respiratory morbidity significantly decreased in relation to gestational age (p < 0.001). Similarly, there was a significant difference in RDS, which was most frequent at 34 weeks (18.2%, p = 0.017). There were no cases of RDS at 36 weeks. Late preterm, singleton, cesarean delivery before labor in mothers who did not receive ACS was associated with a need for ventilation, especially for infants born at 34 and 35 weeks. ACS treatment might therefore be beneficial before elective cesarean section for mothers with a risk of preterm delivery before 35 weeks and 6 days.

Concordance of the risk of neonatal respiratory morbidity assessed by quantitative ultrasound lung texture analysis in fetuses of twin pregnancies

To evaluate the concordance of the risk of neonatal respiratory morbidity (NRM) assessed by quantitative ultrasound lung texture analysis (QuantusFLM) between twin fetuses of the same pregnancy. Prospective study conducted in twin pregnancies. Fetal ultrasound lung images were obtained at 26.0–38.6 weeks of gestation. Categorical (high or low) and continuous results of the risk of NRM were compared between twins. Fetal ultrasound lung images from 131 pairs (262 images) of twins were included. The images were classified into three gestational age ranges: Group 1 (26.0–29.6 weeks, 78 images, 39 pairs [29.8%]); Group 2 (30.0–33.6 weeks, 98 images, 49 pairs [37.4%]) and Group 3 (34.0–38.6 weeks, 86 images, 43 pairs [32.8%]). Concordance was good in Groups 1 and 3 and moderate in Group 2. In Groups 2 and 3 at least one fetus presented high-risk results in 26.5% and 11.6% of twin pairs, respectively. Only gestational age < 32 weeks, gestational diabetes mellitus, and spontaneous conception were associated with a high risk of NRM in Group 2. There was good concordance of the risk of NRM between twins < 30.0 weeks and > 34.0 weeks. From 30.0 to 33.6 weeks 26.5% of the twin pairs had discordant results, with moderate concordance of the risk of NRM.

Meconium - Stained Amniotic Fluid in Labour – its Significance and Correlation to Early Maternal and Neonatal Outcome – A Prospective Case Control Study in A Tertiary Care Center

Background: Meconium-stained amniotic fluid (MSAF) is a well-known factor which associated with significant adverse pregnancy outcomes. Meconium Aspiration Syndrome (MAS) occurs in about 5% of deliveries with MSAF and death occurs in about 12% of infants with MAS. The significance of meconium claimed to be varied from being entirely physiological, which exhibits sign of fetal maturity, to a sign of fetal distress as a response to hypoxic insult to the foetus. This study was carried out in a tertiary care centre; with the aim of detecting the significance of MSAF. Additionally, this study compares the fetal and maternal outcome in deliveries complicated by meconium-stained amniotic fluid and critically evaluates the associated predisposing maternal and fetal factors for MSAF. Method: This prospective case-control study was carried out in Colombo South Teaching Hospital (University Professorial Obstetrics Unit), Sri Lanka. Women who presented to the unit with pre-defined selection protocol were recruited to the study until the sample size (n = 216 in each arm) is achieved. The Sample was categorized in to two groups depend on the presence or absence of Meconium-stained amniotic fluid. Mean, standard deviation, median and 95% confidence interval are computed for quantitative variables. Chi-square test is applied for calculating the statistical significance of variables such as grades of meconium and Apgar score at 95% confidence interval. The p-value &lt;0.05 and 95% confident interval was utilised to assess the statistical significance. Results: Presence of diabetes in current pregnancy was a significant risk factor for meconium-stained amniotic fluid at delivery with odd ratio of 2.397 (95% Confident Interval 1.203 - 3.568) and p value of &lt;0.00.1. There is a statistically significant association between the mode of delivery and the nature of meconium with odd ratio of 3.029 (95% Confident Interval 1.887 – 3.136) and p value &lt; 0.001, when its moderate to thick meconium staining. Presence of moderate to thick meconium increase the risk of neonatal respiratory morbidity with increased NICU admissions, which is both statistically and clinically significant with odd ratio of 2.412 (95% Confident Interval 1.674 - 3.199) and p value 0.005 when compared with thin meconium staining. Overall, there is a 2-fold rise in operative vaginal deliveries and EM-LSCS (Emergency Lower Segment Caesarean Section) in the presence of MSAF which accountable for 67.3% of the deliveries compared to 37.2% in the clear liquor group. The follow up of neonates at one month and three months of life, revealed no statistically significant concerns on the development of these babies in either arm of the study population. Conclusion: Presence of meconium-stained amniotic fluid is one of the common indications for caesarean delivery. Therefore, the results of this study may help to reduce the number caesarean sections carried out when the meconium is detected during labour. Presence of thin MSAF can be physiological following gut maturation of term foetuses, thus utilization of continuous electronic fetal monitoring can reliably cut down the caesarean section rates without adding numbers to the adverse perinatal outcomes. On the other hand, timely interventions upon detection of abnormal Cardiotocography (CTG), such as operative vaginal delivery or EM-LSCS, can significantly minimise these adverse neonatal outcomes. Abnormal CTG in a clinical background of moderate to thick meconium is more alarming, which warrant urgent interventions compared to the presence of thin / lightly stained meconium.

The neonatal respiratory morbidity associated with early term caesarean section – an emerging pandemic

To examine the impact of early term caesarean section (CS) on respiratory morbidity and early neonatal outcomes when elective caesarean section was carried out before 39 completed weeks gestation in our population. A one-year population-based retrospective cohort analysis using routinely collected hospital data. Livebirths from women who had elective lower segment cesarean section (ELSCS) for uncomplicated singleton pregnancies at early term (ET) 37+0 to 38+6 weeks were compared to full term (FT)≥39+0 weeks gestation. Exclusion criteria included diabetes, antenatal corticosteroid use, stillbirths, immediate neonatal deaths, normal vaginal deliveries and emergency caesareans sections. The outcomes were combined respiratory morbidity (tachypnea [TTN] and respiratory distress syndrome [RDS]), Apgar <7 at 5min of age, respiratory support, duration of respiratory support and NICU admission. Out of a total of 1,466 elective CS with term livebirths, the timing of CS was early term (ET) n=758 (52%) and full term (FT) n=708 (48%). There was a higher incidence of respiratory morbidities and neonatal outcomes in the ET in comparison to FT newborns. In the univariable analysis, significant risks for outcomes were: the need for oxygen support OR 2.42 (95% C.I. 1.38-4.22), respiratory distress syndrome and/or transient tachypnea of newborn (RDSF/TTN) OR 2.44 (95% C.I. 1.33-4.47) and neonatal intensive care unit (NICU) admission OR 1.91 (95% C.I. 1.22-2.98). Only the need for oxygen support remained (OR 1.81, 95% C.I. 1.0-3.26) in the multivariable analysis. These results were observed within the context of a significantly higher proportion of older, multiparous, and higher number of previous caesarean sections in the early term CS group. There is a significant risk of respiratory morbidities in infants born by elective cesarean section prior to full term gestation. Obstetricians should aim towards reducing the high rate of women with previous multiple cesarean sections including balancing the obstetric indication of early delivery among such women with the evident risk of neonatal respiratory morbidity.

1127 Trial of labor and neonatal outcomes in pregnancies complicated by diabetes

Diabetes is associated with increased risk of both cesarean delivery and neonatal morbidity. We evaluated the impact of a trial of labor on the risk of neonatal respiratory morbidity and NICU admission among women with pre-gestational and gestational diabetes. Secondary analysis of women from the Consortium on Safe Labor Study (CSL) who delivered at 19 hospitals across the United States. Women with singleton, liveborn, non-anomalous infants with diabetes (gestational and pre-gestational) who delivered at or after 36 0/7 weeks were included. Women who received steroids for fetal benefit at any time during pregnancy were excluded. A trial of labor was defined as at least 2 cervical exams in the CSL database. Our primary outcome was neonatal respiratory morbidity, which included transient tachypnea of the newborn and respiratory distress syndrome. The secondary outcome was NICU admission. We tested for an interaction between labor and diabetes type. Multivariable logistic regression was used to assess the relationship between a trial of labor and neonatal outcomes. Analyses were also stratified by gestational age at delivery. Of the 11,510 women included, 8,755 (76%) had a trial of labor. The majority of women had GDM (81%). There was no interaction between a trial of labor and maternal diabetes type (p=0.47). Compared with pre-labor or scheduled cesarean, delivery after a trial of labor was associated with lower risks of both neonatal respiratory morbidity (0.52, 95%CI 0.41-0.65) and NICU admission (0.68, 95%CI 0.57 - 0.80) after adjusting for covariates (Table). The lower risks of respiratory morbidity and NICU admission associated with a trial of labor was seen at all gestational ages (Table). These data suggest that a trial of labor may reduce the risk of neonatal morbidity compared to scheduled or pre-labor cesarean delivery in pregnancies complicated by diabetes. Further studies are needed to determine optimal timing of delivery for women with gestational and pre-gestational diabetes.

786 Neonatal outcomes in pregnant women with diagnosis of COVID-19

It is unclear whether infection with COVID-19 during pregnancy increases the risk of adverse neonatal outcomes. We tested the hypothesis that a diagnosis of COVID-19 during pregnancy increases the risk of neonatal respiratory morbidity and other adverse neonatal outcomes.

VP44.07: Risk of neonatal respiratory morbidity by QuantusFLM® in twin versus singleton pregnancies

VP44.07: Risk of neonatal respiratory morbidity by QuantusFLM® in twin versus singleton pregnancies

VP44.06: Agreement on the risk of neonatal respiratory morbidity by QuantusFLM® in fetuses of twin pregnancies

VP44.06: Agreement on the risk of neonatal respiratory morbidity by QuantusFLM® in fetuses of twin pregnancies

Counselling Patients for Trial of Labour after Cesarean (TOLAC) and Invasive Placentation: Are We Missing the Mark? The Importance of Local Data and Informed Choice.

Rates of cesarean delivery are increasing, and these procedures carry potential complications, like the risk of invasive placentation, which increases with each cesarean. A trial of labour after cesarean (TOLAC) is a viable option for patients; however, it has been associated with uterine rupture, a complication with maternal and fetal risks. To better counsel patients considering TOLAC, we aimed to determine local uterine rupture rates and maternal and neonatal outcomes with TOLAC and compare these with outcomes related to invasive placentation. A 4-year retrospective chart review was conducted at our tertiary centre of all patients with a history of a previous cesarean delivery. We assessed rates of TOLAC, vaginal delivery after cesarean (VBAC), and uterine rupture, as well as maternal and neonatal outcomes associated with invasive placentation. Cases of uterine rupture from 1988 to the present were also reviewed, and their outcomes were compared with those of invasive placentation. Our uterine rupture rate was 0.44% and VBAC rate was 73.8%. We identified 8 cases of uterine rupture since 1988 and 67 invasive placentas during the 4-year chart review. Invasive placentation was associated with a significantly increased risk of neonatal respiratory morbidity, hysterectomy, maternal complications, and longer length of maternal hospital stay when compared with uterine rupture. While uterine rupture remains a potential complication of TOLAC, it is rare with overall excellent maternal and neonatal outcomes. Invasive placentation, the risk of which increases with cesarean delivery, carries potentially higher complication rates than uterine rupture. Local complication data is important for individual sites offering TOLAC. The implications of invasive placentation cannot be overlooked when counselling patients considering TOLAC.

Assessment of Fetal Lung Maturity Using Quantitative Ultrasound Analysis in Patients with Prelabor Rupture of Membranes

Introduction: Prelabor rupture of membranes (PROM) is a frequent clinical situation, and the decision about the best time for delivery remains controversial, mainly due to the risk of neonatal respiratory morbidity (NRM). Assessment of fetal lung maturity using ultrasound, a safe method and widely used in current obstetrical practice, could change this scenario. This study was designed to evaluate the ability of quantitative ultrasound method QuantusFLM® to predict NRM in patients with PROM and whether maternal BMI, gestational age, occurrence of the disease, and presence of oligohydramnios influenced the performance. Methods: Patients with singleton gestations, diagnosis of PROM, and gestational age between 24 and 38 weeks and 6 days were included. Fetal lung image was acquired by ultrasound within 48 h prior to delivery and analyzed by QuantusFLM®. The results were then paired with neonatal outcomes to assess the program’s ability to predict the NRM in this specific group. A logistic regression model was created to analyze factors that could affect the test results. Results: Fifty-four patients were included. Mean maternal BMI was 28.99 kg/m², and in 25 patients (46.2%), oligohydramnios was observed at the time of examination. Mean gestational age at delivery was 35 weeks and 4 days, and the NRM prevalence was of 18.5%. QuantusFLM® predicted NRM with a 60% sensitivity, 79.5% specificity, 40% positive predictive value, 89.7% negative predictive value, and 75.6% accuracy. Maternal BMI, disease occurrence, presence of oligohydramnios, and gestational age did not interfere with the evaluation. Conclusion: This study demonstrates a good accuracy of QuantusFLM® as a NRM predictor in patients with PROM, with particular reliability in identifying that pulmonary maturity has already occurred.

The majority of early term elective cesarean sections can be postponed

Introduction To minimize the risk of neonatal respiratory morbidity it is recommended that elective cesarean sections should not be done before 39-week gestation unless medically indicated. However, elective cesarean sections are still being performed at early term (at 370–386 weeks gestation) without sound medical indications. In this study, we evaluated the indications for elective cesarean sections performed at early term to assess the proportion of procedures that could possibly have been postponed until ≥39 weeks to avoid neonatal respiratory morbidity. Material and methods Maternal and neonatal information was collected from medical records on all elective cesarean sections performed in singleton pregnancies at ≥370 weeks gestation over a 20-year period in a population with secure ultrasound gestational age assignment. Indications were grouped and uterine scar, breech, or transverse presentation and maternal request classified as nonurgent. Results There were 3411 elective cesarean sections performed at ≥37-week gestation, of which 790 (23.2%) were at 370–386 weeks. Medical indications were present for 34% (272/790), but 65.6% (518/790) could possibly have been postponed until ≥390 weeks. Of the neonates 5.7% developed respiratory morbidity if delivery was at 370–386 weeks gestation compared to 2.4% at 390–421 weeks gestation (p < .001). Conclusion Of elective cesarean sections before 39-week gestation two-thirds were done without a clear medical indication, thereby exposing the newborn to an increased risk of respiratory morbidity. Scheduling elective cesarean sections at ≥39-week gestation is important to minimize the risk of neonatal respiratory morbidity, unless a clear medical indication dictates earlier delivery.

Evaluation of the effect of antenatal betamethasone on neonatal respiratory morbidity in early-term elective cesarean

Background: Compared with vaginal delivery, early-term cesarean section (CS) is associated with an increased risk of neonatal respiratory morbidity. Given the role of steroids in lung maturation in preterm labor, few studies have investigated their effects on early-term delivery. Therefore, this study aimed to investigate the effect of antenatal betamethasone on neonatal respiratory morbidity in early-term elective cesarean (37–38 weeks and 6 d).Methods: This randomized clinical trial was conducted in Mahdieh Hospital in Tehran in 2017. Women with single pregnancy who were candidates for planned elective CS in 37–38 weeks and 6 d of gestation were randomly assigned to either betamethasone group (intramuscular injection of 12 mg of betamethasone in two doses with an interval of 24 h from the 37th week of gestation) or control group (routine treatment). Then, neonatal respiratory morbidities, hospitalization in NICU, and its cause and duration were recorded and compared between the two groups.Results: Of all, 16 neonates (7%) suffered from one or more respiratory morbidities, and there was no significant difference between the betamethasone and control groups (six cases (6%) and 10 cases (9%), respectively, p = .299). There was also no significant difference between betamethasone and control groups in terms of the frequency of respiratory morbidities at the gestational age of 37 and 38 weeks (p > .05). Grunting, retraction, or nasal flaring was the most common respiratory morbidity that was observed in 13 neonates (6%). We observed the need for CPAP in three neonates (1%), respiratory distress syndrome (RDS) in three neonates (1%), transient tachypnea of the newborn (TTN) in two neonates (1%), need for resuscitation at birth in one neonate (0.5%), and apnea in one neonate (0.5%). There was no significant difference between the two groups in terms of respiratory morbidities (p > .05). A total of 17 neonates (8%) were admitted to NICU; the number of neonates admitted to NICU was significantly lower in betamethasone group than in the control group (three neonates (7.2%) and 14 neonates (12.7%), respectively, p = .005). Respiratory distress in 11 neonates (5%), sepsis in two neonates (1%), and other cases in four neonates (2%) were the main reasons for NICU admission. The prevalence of respiratory distress, as a cause for admission, was significantly lower in the betamethasone group (p = .005).Conclusion: The findings of this study showed that intramuscular injection of 12 mg of betamethasone in two doses, with an interval of 24 h, after 37 weeks of gestation in women undergoing early-term CS did not have a significant effect on respiratory morbidities in neonates. However, it decreased the frequency of admission to NICU, especially admission due to respiratory distress; it could indicate that the respiratory morbidities were less severe in betamethasone group than in the control group.

522: Agreement in the risk of neonatal respiratory morbidity by quantusFLM between fetuses of twin pregnancies

522: Agreement in the risk of neonatal respiratory morbidity by quantusFLM between fetuses of twin pregnancies

Antenatal corticosteroids: a retrospective cohort study on timing, indications and neonatal outcome.

An antenatal corticosteroid (ACS) delivery interval of 24 h to seven days is commonly referred to as optimal timing. We aimed to investigate whether the ACS delivery interval was associated with the obstetric indication for treatment and with neonatal complications. The study was a retrospective chart review of clinical data from preterm neonates delivered at the Skåne University Hospital, Lund University, Sweden, from 1 January 2013 to 31 December 2016. The ACS delivery intervals were compared between groups of women with various clinical scenarios and related to neonatal outcomes. The study included 498 preterm neonates from 431 women. One to seven days before delivery, 41% of the women received ACS. Women with preterm prelabor rupture of membranes or vaginal bleeding had a median ACS delivery interval of 7.5 and eight days, respectively, compared with women with maternal/fetal indications or preterm labor (three and two days, respectively) (p < 0.001). Neonates with an ACS delivery interval of more than seven days were at a higher risk of respiratory distress syndrome [odds ratio (OR) 2.00, 95% confidence interval (CI) 1.05-3.79] and moderate or severe bronchopulmonary dysplasia (OR 2.78, 95% CI 1.45-5.33) than were neonates with an ACS delivery interval of one to seven days. Optimal timing of ACS treatment varied significantly based on the clinical indication. Women with preterm prelabor rupture of membranes or vaginal bleeding were more likely to have an ACS delivery interval of more than seven days. A prolonged ACS delivery interval was associated with an increased risk of neonatal respiratory morbidity and a prolonged stay in the neonatal care unit, but not with neonatal mortality.

Increased Neonatal Respiratory Morbidity Associated with Gestational and Pregestational Diabetes: A Retrospective Study.

Objective To examine the risk of neonatal respiratory morbidity associated with gestational and pregestational diabetes, accounting for the prematurity-associated risk using a propensity score analysis. Study design In a retrospective study including 222,978 singleton pregnancies, delivering at 240/7 to 416/7 weeks (2002–2008), we calculated a probability to deliver at term (≥37 weeks of gestation). Outcomes were stratified by the probability to deliver at term (&gt;0.8 and ≤0.8). Adjusted odds ratios (aORs) with 95% confidence intervals (95% CIs) were calculated. Results Gestational and pregestational diabetes complicated 5.1 and 1.5% of pregnancies, respectively, and were associated with increased risks of neonatal respiratory morbidity compared with women without diabetes regardless of probability to deliver at term. However, these risks tended to be higher with a higher probability to deliver at term: respiratory distress syndrome (aOR: 1.5; 95% CI: 1.3–1.7 and aOR: 3.1; 95% CI: 2.6–3.7); transient tachypnea of newborn (aOR: 1.5; 95% CI: 1.3–1.6 and aOR: 2.2; 95% CI: 1.9–2.6); and apnea (aOR: 1.5; 95% CI: 1.2–1.7 and aOR: 3.2; 95% CI: 2.6–3.9, for gestational and pregestational at term, respectively). Conclusion Diabetes was associated with increased risk of neonatal respiratory morbidity beyond what can be attributed to prematurity. Neonatal respiratory morbidities were increased with pregestational diabetes compared with gestational diabetes.

There is Only a Modest Increase in Neonatal Respiratory Morbidity Following Early Term Elective Cesarean in a South Indian Population.

Elective cesarean deliveries (ECD) are still performed prior to 39weeks. This study aimed to identify risk of neonatal respiratory morbidity (NRM) following ECD near term, in a South Indian population. Specifically, study aimed to measure the additional healthcare burden due to large number of ECDs performed prior to 39weeks, in this local population. We analyzed NRM among 1329 deliveries (584 ECD and 745 spontaneous vaginal delivery, SVD) in a tertiary hospital over 2years. Neonates were grouped into: A: 35+0-36+6 weeks, B: 37+0-38+6weeks, and C: ≥39weeks. NRM was compared between ECD versus SVD. Majority (433/584) of ECDs were performed between 37+0 and 38+6 weeks. Overall, 32% received steroid prophylaxis. Of 1329 newborns, 18/584 (3.82%) in ECD and 6/745 (0.8%) in SVD group developed NRM (p value of 0.004, OR 3.9, CI 1.54-9.93). Need of respiratory support among ECD was 4.28% compared to 0.53% in SVD (p<0.001, OR 8.28; CI 2.86-23.94). However, comparing neonates born by ECD between groups B Vs C; there was only a modest increase in NRM (2.07 vs 0.9%; p 0.48, OR 2.3 with CI 0.29-18.4) and in need of respiratory support (2.54 vs 0.9%; p 0.47, OR 2.84; CI 0.36-22.2). NRM following early term ECD continues to be a healthcare burden in India. Interestingly in this South Indian population, early term ECDs caused only modest increase in NRM, and this ethnic variation requires further evaluation to determine ideal time for ECD in local population.

The role of prenatal steroids at 34–36 weeks of gestation

A recent multicentre, double-blind, randomised, placebo-controlled trial has demonstrated that administration of betamethasone to women with threatened preterm delivery at 34–36 weeks of gestational age reduces the risk of neonatal...

Association between timing of elective cesarean delivery and adverse outcomes among women with at least two previous cesareans

To assess the impact of delivery at 37weeks of pregnancy versus 38weeks or later on maternal and neonatal outcomes among women with multiple previous cesareans. In a retrospective study, data were assessed from women with at least two previous cesareans who delivered by cesarean at 37weeks of pregnancy or later at a tertiary referral hospital in Jordan between January 2013 and November 2015. Among 886 eligible women, 505 (57.0%) delivered at 37weeks (group 1) and 381 (43.0%) delivered at 38weeks or later (group 2). There was no difference in intraoperative or postoperative complications between the two groups. In multivariate analysis, women in group 2 had lower odds of delivering neonates with respiratory distress syndrome than did those in group 1 (adjusted odds ratio 0.3, 95% confidence interval 0.2-0.5; P=0.046). However, neonatal jaundice was more common in group 2 (adjusted odds ratio 2.1, 95% confidence interval 1.7-2.7; P=0.035). Among women with multiple cesareans, delivery at 37weeks was associated with increased risk of neonatal respiratory morbidity and decreased risk of neonatal jaundice, but not with a reduction in maternal complications, as compared with delivery at 38 weeks or later.

Effect of early-term birth on respiratory symptoms and lung function in childhood and adolescence.

Early-term-born subjects, (37-38 weeks' gestation), form a large part of the population and have an increased risk of neonatal respiratory morbidity and childhood respiratory symptoms; there is a paucity of data on their later lung function. We sought to (1) compare lung function at 8-9 and 14-17 years in early-term-born children with full-term-born children (39-43 weeks' gestation); (2) assess the role of caesarean section delivery; and (3) compare respiratory symptoms and diagnosis of asthma. Caucasian, singleton, term births from the Avon Longitudinal Study of Parents and Children (n = 14,062) who had lung spirometry at 8-9 (n = 5,465) and/or 14-17 (n = 3,666) years were classified as early or full term. At 8-9 years, standardized spirometry measures, although within the normal range, were lower in the early-term-born group, (n = 911), compared to full-term controls (n = 4,554). Delivery by caesarean section did not influence later spirometry, and the effect of early-term birth was not modified by delivery by caesarean section. At 14-17 years, the spirometry measures in the early-term group, (n = 602), were similar to the full-term group (3,064), and the rates of asthma and respiratory symptoms were also similar between the two gestation groups. Early-term-born children had lower lung function values at 8-9 years compared to the full-term group, but were similar by 14-17 years of age. Delivery at early term should be avoided due to early and late morbidity. Pediatr Pulmonol. 2016;51:1212-1221. © 2016 Wiley Periodicals, Inc.

The risk of neonatal respiratory morbidity according to the etiology of late preterm delivery.

The risk of neonatal respiratory morbidity between indicated deliveries vs. spontaneous deliveries has not been consistent in previous studies, in spite of the traditional belief that chronic intrauterine stress might have protective effect on fetal lung maturation. We hypothesized that the heterogeneous etiology of indicated preterm delivery may obscure the relationship between the etiologies of preterm birth and neonatal respiratory morbidity. To address this issue, we divided the indicated preterm birth (PTB) into medically-indicated (without fetal compromise) PTB and maternal/fetal-indicated PTB, and compared the neonatal respiratory morbidity according to the etiology of late PTB. Neonatal respiratory morbidities were examined in neonates who were delivered between 34+0 and 36+6 weeks of gestation according to the etiology of PTB: 1) medically-indicated PTB (but without fetal compromise), 2) maternal/fetal-indicated PTB, or 3) spontaneous PTB such as preterm labor or preterm premature rupture of membranes. A total of 710 late preterm neonates were included in the study population, including 31 cases of medically-indicated PTB, 202 cases of maternal/fetal-indicated PTB, and 477 cases of spontaneous PTB. The rate of composite respiratory morbidity in cases of medically-indicated PTB is higher than both maternal/fetal-indicated PTB and spontaneous PTB (19% in medically-indicated PTB, 6% in maternal/fetal-indicated PTB, and 7% in spontaneous PTB). This difference between medically-indicated PTB and maternal/fetal-indicated PTB remained significant after adjustment for confounding variables. The medically-indicated PTB is associated with highest risk of neonatal respiratory morbidity in late PTB.