101
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Abstract
Subsequent pregnancies are emotionally traumatic for families with previous stillbirths. Such pregnancies have a 2- to 10-fold increase in the risk for stillbirth as well as an increased probability of other adverse obstetrical outcomes. These medical risks as well as anxiety on the part of families and care providers contribute to an increase in late preterm and early-term birth. However, delivery before 39 weeks' gestation has not been proven to reduce the risk of recurrent stillbirth or adverse pregnancy outcomes in women with previous stillbirths. This work reviews data regarding the optimal timing of delivery in subsequent pregnancies after previous stillbirth, as well as for patients at risk from stillbirth in general. Management recommendations from current data are presented and knowledge gaps are highlighted.
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Affiliation(s)
- Robert M Silver
- Obstetrics and Gynecology, University of Utah Health Sciences Center, Salt Lake City, UT 84132, USA.
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102
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Goyal NK, Fiks AG, Lorch SA. Association of late-preterm birth with asthma in young children: practice-based study. Pediatrics 2011; 128:e830-8. [PMID: 21911345 PMCID: PMC3387906 DOI: 10.1542/peds.2011-0809] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To evaluate the association of late-preterm birth with asthma severity among young children. METHODS A retrospective cohort study was performed with electronic health record data from 31 practices affiliated with an academic medical center. Participants included children born in 2007 at 34 to 42 weeks of gestation and monitored from birth to 18 months. We used multivariate logistic or Poisson models to assess the impact of late-preterm (34-36 weeks) and low-normal (37-38 weeks) compared with term (39-42 weeks) gestation on diagnoses of asthma and persistent asthma, inhaled corticosteroid use, and numbers of acute respiratory visits. RESULTS Our population included 7925 infants (7% late-preterm and 21% low-normal gestation). Overall, 8.3% had been diagnosed with asthma by 18 months. Compared with term gestation, late-preterm gestation was associated with significant increases in persistent asthma diagnoses (adjusted odds ratio [aOR]: 1.68), inhaled corticosteroid use (aOR: 1.66), and numbers of acute respiratory visits (incidence rate ratio: 1.44). Low-normal gestation was associated with increases in asthma diagnoses (aOR: 1.34) and inhaled corticosteroid use (aOR: 1.39). CONCLUSION Birth at late-preterm and low-normal gestational ages might be an important risk factor for the development of asthma and for increased health service use in early childhood.
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Affiliation(s)
- Neera K. Goyal
- Department of Pediatrics, ,Leonard Davis Institute of Health Economics and
| | - Alexander G. Fiks
- Department of Pediatrics, ,Center for Biomedical Informatics, and ,Leonard Davis Institute of Health Economics and ,Center for Clinical Epidemiology and Biostatistics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Scott A. Lorch
- Department of Pediatrics, ,Center for Outcomes Research, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; and ,Leonard Davis Institute of Health Economics and ,Center for Clinical Epidemiology and Biostatistics, School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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103
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Abstract
Over the last 50 years in the United States a rising preterm birth rate, a progressive decrease in preterm mortality, and a lowering of the limit of viability have made preterm birth a significant public health problem. Neuromaturation, the functional development of the central nervous system (CNS), is a dynamic process that promotes and shapes CNS structural development. This article reviews preterm outcomes, recognizing that multiple factors influence neuromaturation and lead to a range of neurodevelopmental disabilities, dysfunctions, and altered CNS processing. Ways to protect preterm infants and support their growth and development in and beyond intensive care are examined.
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Affiliation(s)
- Marilee C Allen
- Division of Neonatology, Department of Pediatrics, Baltimore, MD 21287, USA.
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104
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Abstract
Late preterm and early term infants are at higher risk for short-term and long-term morbidities and mortality than term infants. Such outcomes are influenced by many factors, the strongest of which is gestational age. Counseling and educating women and families about risks of late preterm and early term births is helpful for timing and route of delivery, managing the pregnancy and infant, and prognosticating outcomes for infants.
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Affiliation(s)
- William A Engle
- Section of Neonatal-Perinatal Medicine, Indiana University School of Medicine, Indianapolis, IN 46202, USA.
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105
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Affiliation(s)
- Frank H. Bloomfield
- Liggins Institute and Department of Paediatrics: Child and Youth Health, University of Auckland, Auckland 1142 and the National Research Centre for Growth and Development, New Zealand;
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106
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Ganzevoort W, Sibai BM. Temporising versus interventionist management (preterm and at term). Best Pract Res Clin Obstet Gynaecol 2011; 25:463-76. [DOI: 10.1016/j.bpobgyn.2011.01.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2010] [Accepted: 01/13/2011] [Indexed: 10/18/2022]
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107
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Payne B, Magee LA, von Dadelszen P. Assessment, surveillance and prognosis in pre-eclampsia. Best Pract Res Clin Obstet Gynaecol 2011; 25:449-62. [DOI: 10.1016/j.bpobgyn.2011.02.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Revised: 01/25/2011] [Accepted: 02/04/2011] [Indexed: 01/16/2023]
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108
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Lawlor DA, Mortensen L, Nybo Andersen AM. Mechanisms underlying the associations of maternal age with adverse perinatal outcomes: a sibling study of 264 695 Danish women and their firstborn offspring. Int J Epidemiol 2011; 40:1205-14. [DOI: 10.1093/ije/dyr084] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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109
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Abstract
OBJECTIVE To evaluate trends in adherence to American Academy of Pediatrics recommendations for early discharge of late-preterm newborns and to test the association between hospital characteristics and early discharge. PATIENTS AND METHODS This study was a population-based cohort study using statewide birth-certificate and hospital-discharge data for newborns in California, Missouri, and Pennsylvania from 1993 to 2005. A total of 282 601 late-preterm newborns at 611 hospitals were included. Using logistic regression, we studied the association of early discharge with regional and hospital factors, including teaching affiliation, volume, and urban versus rural location, adjusting for patient factors. RESULTS From 1995 to 2000, early discharge decreased from 71% of the sample to 40%. However, by 2005, 39% were still discharged early. Compared with Pennsylvania, California (adjusted odds ratio [aOR]: 5.95 [95% confidence interval (CI): 5.03-7.04]), and Missouri (aOR: 1.56 [95% CI: 1.26-1.93]) were associated with increased early discharge. Nonteaching hospitals were more likely than teaching hospitals to discharge patients early if they were uninsured (aOR: 1.91 [95% CI: 1.35-2.69]) or in a health maintenance organization plan (aOR: 1.40 [95% CI: 1.06-1.84]) but not patients with fee-for-service insurance (aOR: 1.04 [95% CI: 0.80-1.34]). A similar trend for newborns on Medicaid was not statistically significant (aOR: 1.77 [95% CI: 0.95-3.30]). CONCLUSIONS Despite a decline in the late 1990s, early discharge of late-preterm newborns remains common. We observe differences according to state, hospital teaching affiliation, and patient insurance. Additional research on the safety and appropriateness of early discharge for this population is necessary.
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Affiliation(s)
- Neera K Goyal
- Robert Wood Johnson Foundation Clinical Scholars, University of Pennsylvania, 423 Guardian Dr, 1310 Blockley Hall, Philadelphia, PA 19104, USA.
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110
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[Short-term complications of late preterm infants]. An Pediatr (Barc) 2011; 75:169-74. [PMID: 21684230 DOI: 10.1016/j.anpedi.2011.04.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2010] [Revised: 04/04/2011] [Accepted: 04/22/2011] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Late preterm infants, born at 34-36(+6) weeks gestation, are physiologically more immature than term infants. As a consequence, they have an increased risk of morbidity and mortality. Since health outcomes in prematurity may change depending on local factors we have proposed determine the short-term medical problems of these infants in our hospital. PATIENTS AND METHODS A retrospective observational study was carried out on all newborn ≥ 34 weeks gestation admitted to Virgen del Rocio hospital from May 2005 to December 2008. We divided this cohort into late preterm (34-36(+6) weeks, n=769) and term (37-41(+6) weeks, n=1460) groups. We compared mortality and morbidity data between the 2 groups. RESULTS Late preterm group was associated with assisted reproduction, twin pregnancy, caesarean delivery and preeclampsia during pregnancy. The risk of hospitalization was six times greater in these infants and neonatal intensive care admissions were twice as common. The hospital stay was double in this group. Neonatal respiratory morbidity and jaundice were greater in the preterm group. The use of surfactant, oxygen and respiratory support (CPAP and CMV) was also higher. There were no significant differences in hypoglycaemia and neonatal mortality between both groups. CONCLUSIONS Late preterm infants represent a well-defined risk group for developing complications and should be available the necessary resources should be made available for their special care.
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111
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Fléchelles O, Romagnan L. La prématurité modérée est-elle un problème en Martinique ? Éclairage à partir d’une enquête épidémiologique. Arch Pediatr 2011. [DOI: 10.1016/s0929-693x(11)70961-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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112
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Maternal preeclampsia and neonatal outcomes. J Pregnancy 2011; 2011:214365. [PMID: 21547086 PMCID: PMC3087144 DOI: 10.1155/2011/214365] [Citation(s) in RCA: 231] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2010] [Accepted: 02/08/2011] [Indexed: 12/02/2022] Open
Abstract
Preeclampsia is a multiorgan, heterogeneous disorder of pregnancy associated with significant maternal and neonatal morbidity and mortality. Optimal strategies in the care of the women with preeclampsia have not been fully elucidated, leaving physicians with incomplete data to guide their clinical decision making. Because preeclampsia is a progressive disorder, in some circumstances, delivery is needed to halt the progression to the benefit of the mother and fetus. However, the need for premature delivery has adverse effects on important neonatal outcomes not limited to the most premature infants. Late-preterm infants account for approximately two thirds of all preterm deliveries and are at significant risk for morbidity and mortality. Reviewed is the current literature in the diagnosis and obstetrical management of preeclampsia, the outcomes of late-preterm infants, and potential strategies to optimize fetal outcomes in pregnancies complicated by preeclampsia.
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113
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Picone S, Paolillo P. Neonatal outcomes in a population of late-preterm infants. J Matern Fetal Neonatal Med 2011; 23 Suppl 3:116-20. [PMID: 20822332 DOI: 10.3109/14767058.2010.509921] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The late-preterm infants are a group of premature steadily increasing, different from term infants as immature in terms of respiratory, metabolic, neurological, and immunological features. They may present at birth and during the first week of life various diseases and brain lesions echographically evident. We analyzed the neonatal outcomes of 417 late-preterm infants, born in our Department of Neonatology in a period of two and a half years, evaluating respiratory problems (RDS, transient tachypnea, pneumonia, pneumothorax, and apnea), metabolic problems (hypoglycemia, hypomagnesemia, hypo-hypernatremia, dehydration, hypocalcemia, and hyperbilirubinemia), infections, neurological symptoms associated with electrolyte disturbances, the disease patterns observed by ultrasound examination of the brain, the kidney ultrasound images, genital malformations.
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Affiliation(s)
- S Picone
- Department of Neonatology, Neonatal Intensive Care Unit, Casilino General Hospital, Rome, Italy
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114
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Baron IS, Erickson K, Ahronovich MD, Baker R, Litman FR. Cognitive deficit in preschoolers born late-preterm. Early Hum Dev 2011; 87:115-9. [PMID: 21131147 DOI: 10.1016/j.earlhumdev.2010.11.010] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2010] [Revised: 11/10/2010] [Accepted: 11/16/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND late-preterm (LPT) birth accounts for a majority of preterm deliveries and until recently was considered low risk for poor cognitive outcome. Previously, we reported deficits in complicated LPT (cLPT) preschoolers (neonatal intensive care unit [NICU]-admitted). AIM to extend our prior study by comparing cognitive outcome in cLPT and uncomplicated LPT (uLPT; NICU non-admitted) preschoolers. STUDY DESIGN single center retrospective cohort study of 118 LPT children born in 2004-2006 at 35-36 weeks of gestation; 90 cLPT and 28 uLPT, compared with 100 term-born (≥ 37 weeks of gestation and ≥ 2500 g) participants. OUTCOME MEASURE a well-standardized measure of general conceptual ability (GCA), the Differential Ability Scales, Second Edition. RESULTS cLPT participants had average mean performances but significantly poorer GCA, Nonverbal Reasoning, and Spatial scores than term-born children, and higher rates of Nonverbal Reasoning and Spatial impairment; uLPT did not differ from TERM. Combined LPT males were at eightfold greater risk than term-born males for nonverbal deficit, and at sevenfold greater risk for GCA impairment than LPT females. CONCLUSIONS finding greater risk of cognitive deficit in those NICU-admitted due to clinical instability or birth weight < 2 kg compared with non-admitted preschoolers indicates that neonatal morbidities contribute to subtle cognitive deficits detectable at young age, with male gender an additive risk factor. LPT gestational age alone is an insufficient predictor of long-term neurocognitive outcome. Further study should elucidate salient etiologies for early emerging cognitive weaknesses and suggest appropriate interventions to prepare at-risk LPT preschoolers for elementary school entry.
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Affiliation(s)
- Ida Sue Baron
- Department of Pediatrics, Inova Fairfax Hospital for Children, Falls Church, VA, United States.
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115
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Abstract
OBJECTIVE To synthesize the published research pertaining to breastfeeding establishment and outcomes among late preterm infants and to describe the state of the science on breastfeeding within this population. DATA SOURCES Online databases Ovid MEDLINE, CINAHL, PubMed, and reference lists of reviewed articles. STUDY SELECTION Nine data-based research articles examining breastfeeding patterns and outcomes among infants born between 34 0/7 and 36 6/7 weeks gestation or overlapping with this time period by at least 2 weeks. DATA EXTRACTION Effect sizes and descriptive statistics pertaining to breastfeeding initiation, duration, exclusivity, and health outcomes among late preterm breastfed infants. DATA SYNTHESIS Among late preterm mother/infant dyads, breastfeeding initiation appears to be approximately 59% to 70% (U.S.), whereas the odds of breastfeeding beyond 4 weeks or to the recommended 6 months (exclusive breastfeeding) appears to be significantly less than for term infants, and possibly less than infants ≤34 to 35 weeks gestation. Breastfeeding exclusivity is not routinely reported. Rehospitalization, often related to "jaundice" and "poor feeding," is nearly twice as common among late preterm breastfed infants as breastfed term or nonbreastfed late preterm infants. Barriers to optimal breastfeeding in this population are often inferred from research on younger preterm infants, and evidence-based breastfeeding guidelines are lacking. CONCLUSIONS Late preterm infants are at greater risk for breastfeeding-associated rehospitalization and poor breastfeeding establishment compared to their term (and possibly early preterm) counterparts. Contributing factors have yet to be investigated systematically.
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Affiliation(s)
- Jill V Radtke
- School of Nursing, University of Pittsburgh, 3500 Victoria Street, Pittsburgh, PA 15261, USA.
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116
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Early neonatal morbidities in late preterm infants. Indian Pediatr 2010; 48:607-11. [DOI: 10.1007/s13312-011-0105-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2010] [Accepted: 06/28/2010] [Indexed: 11/27/2022]
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117
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Pulver LS, Denney JM, Silver RM, Young PC. Morbidity and discharge timing of late preterm newborns. Clin Pediatr (Phila) 2010; 49:1061-7. [PMID: 20724328 DOI: 10.1177/0009922810376821] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Late preterm newborns (LPNs), those with gestational ages (GAs) between 34 weeks and 36 weeks 6 days, account for 70% of preterm births. Because they have a mature appearance and are often cared for in a well baby nursery (WBN), parents may anticipate that the nursery course will be similar to that of a term infant and that their newborn will be discharged with his/her mother. How frequently their hospitalizations are prolonged beyond that of their mothers and the morbidities associated with prolonged hospitalization (PH) have not been well described. The objectives of the study were to (1) determine the proportion of LPNs with a PH and (2) describe the most common morbidities in LPNs and identify those associated with PH. The authors conducted retrospective chart reviews of the neonatal courses of LPNs born between December 2002 and April 2007 at the University of Utah Hospital. They compared maternal and newborn discharge dates to determine the proportion of LPNs with a PH and calculated frequencies of conditions and interventions indicating morbidity and identified associations between each of the conditions/interventions and PH. Of 235 LPNs, 94 (40%) had a PH; 75% of 34-week LPNs had a PH compared with 50% of those with GAs of 35 weeks and 25% of those with GAs of 36 weeks. The most common conditions/interventions were an oxygen need, phototherapy for jaundice, and hypothermia requiring an isolette. A need for nasogastric feeding and antibiotic administration for >3 days was consistently associated with a PH. LPNs whose only intervention was phototherapy for jaundice or IV antibiotics for <3 days did not have a PH. As a group, two thirds of LPNs experienced one or more conditions/interventions indicating morbidity, and 40% had a PH. Both were much more common in LPNs with GAs of 34 weeks compared with LPNs with GAs of 36 weeks. Nursery clinicians should counsel parents of LPNs regarding the likely possibility of morbidity and PH.
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118
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Halldorsson TI, Strøm M, Petersen SB, Olsen SF. Intake of artificially sweetened soft drinks and risk of preterm delivery: a prospective cohort study in 59,334 Danish pregnant women. Am J Clin Nutr 2010; 92:626-33. [PMID: 20592133 DOI: 10.3945/ajcn.2009.28968] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Sugar-sweetened soft drinks have been linked to a number of adverse health outcomes such as high weight gain. Therefore, artificially sweetened soft drinks are often promoted as an alternative. However, the safety of artificial sweeteners has been disputed, and consequences of high intakes of artificial sweeteners for pregnant women have been minimally addressed. OBJECTIVE We examined the association between intakes of sugar-sweetened and artificially sweetened soft drinks and preterm delivery. DESIGN We conducted prospective cohort analyses of 59,334 women from the Danish National Birth Cohort (1996-2002). Soft drink intake was assessed in midpregnancy by using a food-frequency questionnaire. Preterm delivery ( lt 37 wk) was the primary outcome measure. Covariate information was assessed by telephone interviews. RESULTS There was an association between intake of artificially sweetened carbonated and noncarbonated soft drinks and an increased risk of preterm delivery (P for trend: le 0.001, both variables). In comparison with women with no intake of artificially sweetened carbonated soft drinks, the adjusted odds ratio for women who consumed ge 1 serving of artificially sweetened carbonated soft drinks/d was 1.38 (95% CI: 1.15, 1.65). The corresponding odds ratio for women who consumed ge 4 servings of artificially sweetened carbonated soft drinks/d was 1.78 (95% CI: 1.19, 2.66). The association was observed for normal-weight and overweight women. A stronger increase in risk was observed for early preterm and moderately preterm delivery than with late-preterm delivery. No association was observed for sugar-sweetened carbonated soft drinks (P for trend: 0.29) or for sugar-sweetened noncarbonated soft drinks (P for trend: 0.93). CONCLUSIONS Daily intake of artificially sweetened soft drinks may increase the risk of preterm delivery. Further studies are needed to reject or confirm these findings.
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119
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Dimitriou G, Fouzas S, Georgakis V, Vervenioti A, Papadopoulos VG, Decavalas G, Mantagos S. Determinants of morbidity in late preterm infants. Early Hum Dev 2010; 86:587-91. [PMID: 20729014 DOI: 10.1016/j.earlhumdev.2010.07.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 07/15/2010] [Accepted: 07/24/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess the effect of selected maternal medical conditions and complications of pregnancy on the risk for morbidity among late preterm neonates. DESIGN Prospective cohort study. MATERIAL AND METHODS A total of 548 late preterm neonates (34(0/7) to 36(6/7)weeks' gestation) delivered from August 2006 to July 2009, were included. Information regarding demographics, gestational age, mode of delivery, maternal age and parity, pre-existing medical conditions and complications of pregnancy were obtained and associated with neonatal morbidity, both independently and as joint exposures. Newborn morbidity was defined by combining specific diagnoses, length of hospital stay, and transfer to the Neonatal Intensive Care Unit. RESULTS Overall, 165 (30.1%) of the late preterm infants suffered from morbidity. The morbidity rates were 16.8% at 36 weeks' gestation, and then approximately doubled from 38.2% at 35 weeks to 59.7% at 34 weeks. The joint effect of gestational age (OR 8.43 for 34 weeks and 3.60 for 35 weeks' gestation), small for gestational age (SGA) (OR 4.18), multiple gestation (OR 3.68) and lack of antenatal steroid administration (OR 4.03), was greater than the independent effect of each of these factors, and greater than additive. Emergency caesarean section (OR 1.43) and antepartum haemorrhage (OR 3.07) were also associated with a significant impact on neonatal morbidity. CONCLUSIONS The risk for morbidity among late preterm infants, changes with each passing week of gestation. This risk seems to be intensified, when other exposures such as SGA, multiple gestation, emergency caesarean section, lack of antenatal steroid administration and antepartum haemorrhage, are also present.
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Affiliation(s)
- Gabriel Dimitriou
- Neonatal Intensive Care Unit, Department of Pediatrics, University of Patras Medical School, Rio, Patras, Greece.
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120
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Suzuki S, Inde Y, Miyake H. Comparison of short-term outcomes of late pre-term singletons and dichorionic twins and optimal timing of delivery. J OBSTET GYNAECOL 2010; 30:574-7. [DOI: 10.3109/01443615.2010.494207] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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121
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Gunville CF, Sontag MK, Stratton KA, Ranade DJ, Abman SH, Mourani PM. Scope and impact of early and late preterm infants admitted to the PICU with respiratory illness. J Pediatr 2010; 157:209-214.e1. [PMID: 20338574 PMCID: PMC2892737 DOI: 10.1016/j.jpeds.2010.02.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2009] [Revised: 12/21/2009] [Accepted: 02/04/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To determine the clinical course and outcomes of children born early preterm (EPT, <32 weeks), late preterm (LPT, 32 to 35 weeks), and full term (FT, >or=36 weeks) who were subsequently admitted to the pediatric intensive care unit (PICU) with respiratory illness. STUDY DESIGN Retrospective chart review of patients <2 years old admitted to a tertiary PICU with respiratory illness. RESULTS Two hundred seventy-one patients met inclusion criteria: 17.3% were EPT, 12.2% were LPT, and 70.5% were FT. Lower respiratory tract infection was the most common diagnosis (55%) for all groups. Median PICU length of stay was longer for EPT (6.3 days) and LPT infants (7.1 days) compared with FT infants (3.7 days; P < .03 for both comparisons). EPT and LPT infants had longer hospital stays (median, 11.7 and 13.8 days, respectively) compared with FT infants (median, 7.1 days; P < .03 and P = .004, respectively). Median hospital charges were also greater for EPT ($85 151) and LPT ($83 576) groups compared with FT group ($55 122; P < .01 and P < .02, respectively). CONCLUSIONS EPT and LPT infants comprise a considerable proportion of PICU admissions for respiratory illness and have greater resource utilization than FT infants.
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Affiliation(s)
| | - Marci K. Sontag
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Denver
| | | | | | - Steven H. Abman
- Section of Pulmonary Medicine, Pediatric Heart Lung Center, Department of Pediatrics, University of Colorado Denver, School of Medicine
| | - Peter M. Mourani
- Section of Critical Care, Pediatric Heart Lung Center, Department of Pediatrics, University of Colorado Denver, School of Medicine
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122
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Bird TM, Bronstein JM, Hall RW, Lowery CL, Nugent R, Mays GP. Late preterm infants: birth outcomes and health care utilization in the first year. Pediatrics 2010; 126:e311-9. [PMID: 20603259 DOI: 10.1542/peds.2009-2869] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To distinguish the effects of late preterm birth from the complications associated with the causes of delivery timing, this study used propensity score-matching methods on a statewide database that contains information on both mothers and infants. METHODS Data for this study came from Arkansas Medicaid claims data linked to state birth certificate data for the years 2001 through 2005. We excluded all multiple births, infants with birth defects, and infants at <33 weeks of gestation. Late preterm infants (LPIs) (34 to 36 weeks of gestation) were matched with term infants (37-42 weeks of gestation) according to propensity scores, on the basis of infant, maternal, and clinical characteristics. RESULTS A total of 5188 LPIs were matched successfully with 15303 term infants. LPIs had increased odds of poor outcomes during their birth hospitalization, including a need for mechanical ventilation (adjusted odds ratio [aOR]: 1.31 [95% confidence interval [CI]: 1.01-1.68]), respiratory distress syndrome (aOR: 2.84 [95% CI: 2.33-3.45]), and hypoglycemia (aOR: 1.60 [95% CI: 1.26-2.03]). Outpatient and inpatient Medicaid expenditures in the first year were both modestly higher (outpatient, adjusted marginal effect: $108 [95% CI: $58-$158]; inpatient, $597 [95% CI: $528-$666]) for LPIs. CONCLUSIONS LPIs are at increased risk of poor health-related outcomes during their birth hospitalization and of increased health care utilization during their first year.
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Affiliation(s)
- T Mac Bird
- Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
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123
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Kalyoncu Ö, Aygün C, Çetİnoğlu E, Küçüködük S. Neonatal morbidity and mortality of late-preterm babies. J Matern Fetal Neonatal Med 2010. [PMID: 19757335 DOI: 10.3109/14767050903229622] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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124
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Colin AA, McEvoy C, Castile RG. Respiratory morbidity and lung function in preterm infants of 32 to 36 weeks' gestational age. Pediatrics 2010; 126:115-28. [PMID: 20530073 PMCID: PMC3000351 DOI: 10.1542/peds.2009-1381] [Citation(s) in RCA: 179] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Normal lung development follows a series of orchestrated events. Premature birth interrupts normal in utero lung development, which results in significant alterations in lung function and physiology. Increasingly, there are reports documenting the broad range of complications experienced by infants aged 34 to 36 weeks' gestational age (GA). Our objective was to summarize the evidence demonstrating respiratory system vulnerability in infants aged 34 to 36 weeks' GA and to review the developmental and physiologic principles that underlie this vulnerability. A comprehensive search for studies that reported epidemiologic data and respiratory morbidity was conducted on the PubMed, Medline, Ovid Biosis, and Embase databases from 2000 to 2009 by using medical subject headings "morbidity in late preterm infants," "preterm infants and lung development," "prematurity and morbidity," and "prematurity and lung development." Because the number of studies exclusive to infants aged 34 to 36 weeks' GA was limited, selected studies also included infants aged 32 to 36 weeks' GA. Of the 24 studies identified, 16 were retrospective population-based cohort studies; 8 studies were observational. These studies consistently revealed that infants born at 32 to 36 weeks' GA, including infants of 34 to 36 weeks' GA, experience substantial respiratory morbidity compared with term infants. Levels of morbidity were, at times, comparable to those observed in very preterm infants. The developmental and physiologic mechanisms that underlie the increased morbidity rate and alterations in respiratory function are discussed. We also present evidence to demonstrate that the immaturity of the respiratory system of infants 34 to 36 weeks' GA at birth results in increased morbidity in infancy and leads to deficits in lung function that may persist into adulthood.
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Affiliation(s)
- Andrew A Colin
- Division of Pediatric Pulmonology, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
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126
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Gouyon JB, Vintejoux A, Sagot P, Burguet A, Quantin C, Ferdynus C. Neonatal outcome associated with singleton birth at 34-41 weeks of gestation. Int J Epidemiol 2010; 39:769-76. [DOI: 10.1093/ije/dyq037] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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127
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Gotsch F, Gotsch F, Romero R, Erez O, Vaisbuch E, Kusanovic JP, Mazaki-Tovi S, Kim SK, Hassan S, Yeo L. The preterm parturition syndrome and its implications for understanding the biology, risk assessment, diagnosis, treatment and prevention of preterm birth. J Matern Fetal Neonatal Med 2010; 22 Suppl 2:5-23. [PMID: 19951079 DOI: 10.1080/14767050902860690] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Francesca Gotsch
- Perinatology Research Branch, NICHD/NIH/DHHS, Bethesda, Maryland, USA
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128
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Zanardo V, Weiner G, Micaglio M, Doglioni N, Buzzacchero R, Trevisanuto D. Delivery room resuscitation of near-term infants: Role of the laryngeal mask airway. Resuscitation 2010; 81:327-30. [DOI: 10.1016/j.resuscitation.2009.11.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Revised: 11/11/2009] [Accepted: 11/12/2009] [Indexed: 11/28/2022]
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Abstract
OBJECTIVES To estimate women's understanding of the definition of full term and the gestational age at which it is safe to deliver an otherwise healthy pregnancy. METHODS A national sample of 650 insured women who recently gave birth were surveyed about their beliefs related to the meaning of full term and the safety of delivery at various gestational ages. Descriptive statistics including means and 95% confidence intervals were calculated for the demographic variables and survey measures; multivariate logistic regression analyses were also performed. RESULTS Twenty-four percent of women surveyed considered a baby of 34-36 weeks of gestation to be full term, and 50.8% believed full term to occur at 37-38 weeks of gestation, while only 25.2% considered full term to occur at 39-40 weeks of gestation. In response to, "What is the earliest point in pregnancy that it is safe to deliver the baby, should there be no other medical complications requiring early delivery?" 51.7% choose 34-36 weeks of gestation, and 40.7% choose 37-38 weeks of gestation, while only 7.6% choose 39-40 weeks of gestation. CONCLUSION The American College of Obstetricians and Gynecologists recommends that elective deliveries not occur before 39 weeks of gestation. However, many women believe that full term is reached before 37 weeks of gestation, and most believe full term occurs before 39 weeks of gestation. Nearly half believe it is safe to deliver before 37 weeks of gestation, and almost all believe it is safe to deliver before 39 weeks of gestation. The data reported here suggest that many women believe that term is reached early and that a safe delivery does not require waiting to 39 weeks of gestation. LEVEL OF EVIDENCE III.
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130
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Baron IS, Erickson K, Ahronovich MD, Coulehan K, Baker R, Litman FR. Visuospatial and verbal fluency relative deficits in 'complicated' late-preterm preschool children. Early Hum Dev 2009; 85:751-4. [PMID: 19879072 DOI: 10.1016/j.earlhumdev.2009.10.002] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Revised: 09/17/2009] [Accepted: 10/09/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Late-preterm children constitute a majority of all preterm deliveries (75%). Their immature brain development at birth has been associated with an increased risk for morbidities. Data have been sparse regarding neuropsychological outcomes in the preschool years. AIM To examine general cognition, attention/working memory, language, manual coordination/motor dexterity, visuomotor, visuospatial, and executive functions in preschoolers born late-preterm (LPT; 34-36 gestational weeks) who required NICU admission compared to term-born participants. DESIGN Single-center retrospective cohort study of 95 three-year-old children; 60 born LPT in 2004-2005 and admitted to the NICU compared to 35 healthy term-born participants born > or =37 gestational weeks and > or =2500 g. RESULTS LPT birth was associated with visuospatial (p=.005), visuomotor (p=.012), and executive function (noun [p=.018] and action-verb [p=.026] fluency) relative deficits, but not attention/working memory, receptive or expressive language, nonverbal reasoning, or manual coordination/dexterity deficit. CONCLUSIONS Late-preterm birth is likely to be associated with negative neuropsychological sequelae, although subtle and selective compared to effects reported for children born at an earlier gestational age. Visuospatial function appears to be especially vulnerable to disruption even at preschool age, and verbal fluency may be useful as an early predictor of executive dysfunction in childhood. Routine preschool neuropsychological evaluation is recommended to identify delay or deficit in LPT children preparing for school entry, and may highlight underlying vulnerable neural networks in LPT children.
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Affiliation(s)
- Ida Sue Baron
- Department of Pediatrics, Inova Fairfax Hospital for Children, 3300 Gallows Road, Falls Church, Virginia 22042, USA.
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Kitsommart R, Janes M, Mahajan V, Rahman A, Seidlitz W, Wilson J, Paes B. Outcomes of late-preterm infants: a retrospective, single-center, Canadian study. Clin Pediatr (Phila) 2009; 48:844-50. [PMID: 19596865 DOI: 10.1177/0009922809340432] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To study the prevalence of major morbidities and mortality of inborn, late-preterm infants. Methods. A retrospective review was conducted from 2004 to 2008. Descriptive outcomes were compared with predefined aggregate outcomes of term infants during the same period. RESULTS Data on 1193 late-preterm and 8666 term infants were compared. Majority of late-preterm infants were 36 weeks (43.6%), followed by 35 weeks (29.2%) and 34 weeks (27.2%), respectively. The prevalence of intensive care admission, respiratory support, pneumothorax, and mortality in late preterm infants was significantly higher compared with term infants. Mechanical ventilation and continuous positive airway pressure rates substantially decreased with increased gestational age. Although only 1.0% had positive cultures, 28.5% received parenteral antibiotics. The late-preterm group had a 12-fold higher risk of death with an overall mortality rate of 0.8%. CONCLUSION This study confirmed the high-risk status of late-preterm infants with worse mortality and morbidities compared with term infants.
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Embryo transfer practices in the United States: a survey of clinics registered with the Society for Assisted Reproductive Technology. Fertil Steril 2009; 94:1432-1436. [PMID: 19748089 DOI: 10.1016/j.fertnstert.2009.07.987] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2009] [Revised: 07/09/2009] [Accepted: 07/13/2009] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To gain a better understanding of factors influencing clinicians' embryo transfer practices. DESIGN Cross-sectional survey. SETTING Web-based survey conducted in December 2008 of individuals practicing IVF in centers registered with the Society for Assisted Reproductive Technology (SART). PATIENT(S) None. INTERVENTION(S) None. MAIN OUTCOME MEASURE(S) Prevalence of clinicians reporting following embryo transfer guidelines recommended by the American Society for Reproductive Medicine (ASRM), prevalence among these clinicians to deviate from ASRM guidelines in commonly encountered clinical scenarios, and practice patterns related to single embryo transfer. RESULT(S) Six percent of respondents reported following their own, independent guidelines for the number of embryos to transfer after IVF. Of the 94% of respondents who reported routinely following ASRM embryo transfer guidelines, 52% would deviate from these guidelines for patient request, 51% for cycles involving the transfer of frozen embryos, and 70% for patients with previously failed IVF cycles. All respondents reported routinely discussing the risks of multiple gestations associated with standard embryo transfer practices, whereas only 34% reported routinely discussing single embryo transfer with all patients. CONCLUSION(S) Although the majority of clinicians responding to our survey reported following ASRM embryo transfer guidelines, at least half would deviate from these guidelines in a number of different situations.
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Guasch XD, Torrent FR, Martínez-Nadal S, Cerén CV, Saco MJE, Castellví PS. [Late preterm infants: A population at underestimated risk]. An Pediatr (Barc) 2009; 71:291-8. [PMID: 19647501 DOI: 10.1016/j.anpedi.2009.06.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2009] [Revised: 05/12/2009] [Accepted: 06/01/2009] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND OBJECTIVE There has been a gradual rise in prematurity rates recent years, almost exclusively at the expense of the late preterm (34 to 36 weeks). This population, although with less risk than smaller preterm gestational age, has a morbidity rate significantly higher than term infants. However, there is some underestimation regarding developments in the short and long term. The aim of this study was to look at the incidence of prematurity in our institution and to analyze morbidity and mortality in late preterm compared with term infants SUBJECTS AND METHODS We performed a retrospective review of newborns in our Hospital from January 1992 until December 31, 2008. Late preterm group was defined as between 34(0/7) and 36(6/7) weeks gestation (N=2003) and term infants from 37 to 42 weeks gestation (N=32015). We formed 2 subgroups according two time periods (1992-1998 and 2000-2008). The morbidity and mortality for each of the groups and subgroups, and the morbidity from week 34 to 42, were analysed and compared. RESULTS During the period studied, the prematurity rate increased from 3.9% to 9.8%, exclusively at the expense of the late preterm (79%). The rate of mortality in late preterm was 5 per thousand compared to 1.1 per thousand in the term (P <0.0001, OR 4.71, 95% CI 2.3-9.5). The incidence of admission to the Neonatal Unit, Cesarean rate, twin, respiratory disorders, need for respiratory support in the form of nasal CPAP or mechanical ventilation, incidence of apnea, jaundice requiring phototherapy, hypoglycaemia and need for parenteral nutrition were significantly higher (P<0.0001) in the late preterm group compared with term infants. The morbidity rate decreased significantly as gestational age increased, with the lowest value from 39 weeks. CONCLUSIONS Morbidity and mortality in late preterm infants is significantly higher than in term infants. The guidelines for these near term premature babies need to be reviewed, looking for possible causes of prematurity, and trying to reduce their impact, as well as developing a protocol for their care and close monitoring to minimize the associated morbidity. There should be long-term monitoring to find out the consequences on their psychomotor development. The obstetrics group should be made aware of the true risks of births in the near-term gestational ages.
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Robinson JL. Comment and reply on: The cost-effectiveness of palivizumab for respiratory syncytial virus prophylaxis in premature infants with a gestational age of 32-35 weeks: a Canadian-based analysis. Curr Med Res Opin 2009; 25:1631-2; author reply 1632-3. [PMID: 19480611 DOI: 10.1185/03007990902993415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Abstract
Advances in antenatal medicine and neonatal intensive care have successfully resulted in improved survival rates of preterm infants. These improvements have been most dramatic in infants born extremely low birth weight (ELBW, <or=1000 g) and at the limits of viability (22 to 25 weeks). But improvements in survival have not been accompanied by proportional reductions in the incidence of disability in this population. Thus, survival is not an adequate measure of success in these infants who remain at high risk for neurodevelopmental and behavioral morbidities. There is now increasing evidence of sustained adverse outcomes into school age and adolescence, not only for ELBW infants but for infants born late preterm.
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Guglani L, Ryan RM, Lakshminrusimha S. Risk factors and management of transient tachypnea of the newborn. ACTA ACUST UNITED AC 2009. [DOI: 10.2217/phe.09.24] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Transient tachypnea of the newborn (TTN) is the consequence of delayed clearance of fetal lung liquid in the newborn. With recognition of the increased risk in babies born by Cesarean sections, epidemiologic association with maternal asthma and increasing research on the possible role of genetic polymorphisms of ion-channel subunits, our understanding of the pathophysiology of this condition has vastly improved. We now know that the late-preterm infant, born at 34–36 weeks gestation, is at increased risk for both TTN and respiratory distress syndrome due to surfactant deficiency. As the incidence of Cesarean sections rises, there is likelihood of increased respiratory morbidity in newborns that will necessitate additional medical interventions and exposure to complications of intensive care. This review focuses on the risk factors that are associated with the development of TTN and the treatment strategies that are employed for the management of this condition.
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Affiliation(s)
- Lokesh Guglani
- Division of Pediatric Pulmonology, Children’s Hospital of Pittsburgh, Children’s Hospital Drive, 45th St and Penn Avenue, Pittsburgh, PA 15201 USA
| | - Rita M Ryan
- Chief, Division of Neonatology, Professor of Pediatrics, Pathology & Anatomical Sciences, Gynecology-Obstetrics Director, Neonatal-Perinatal Medicine Fellowship Program, Director, Center for Developmental Biology of the Lung University at Buffalo, Women & Children’s Hospital of Buffalo 219 Bryant Street Buffalo, NY 14222-2006, USA
| | - Satyan Lakshminrusimha
- Associate Professor of Pediatrics, Division of Neonatology, Associate Program Director, Neonatal-Perinatal Medicine Fellowship Program, University at Buffalo, Women & Children’s Hospital of Buffalo, 219 Bryant Street, Buffalo, NY 14222-2006, USA
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Pulver LS, Guest-Warnick G, Stoddard GJ, Byington CL, Young PC. Weight for gestational age affects the mortality of late preterm infants. Pediatrics 2009; 123:e1072-7. [PMID: 19482740 DOI: 10.1542/peds.2008-3288] [Citation(s) in RCA: 88] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Late preterm infant mortality is higher than that for term newborns. The association between weight for gestational age (WGA) category and late preterm mortality has not been well described. OBJECTIVES Our objectives for this research were as follows: (1) to compare neonatal and infant mortality rates of SGA, AGA, and LGA late preterm, early term, and term newborns; (2) to determine the relative risk of neonatal and infant death for each WGA category; and (3) to examine causes of neonatal and infant death. METHODS We reviewed linked birth and death certificate data for all infants from Utah born between 1999 and 2005 with a GA > or =34 weeks. We calculated neonatal and infant mortality rates for each GA/birth weight stratum and estimated mortality rate ratios using AGA term infants as the reference. International Classification of Diseases, Ninth Revision, codes were used to classify cause of death. RESULTS There were 343322 newborns with GA > or =34 weeks from 1999 to 2005. Late preterm SGA infants were approximately 44 times more likely than term AGA newborns to die in their first month and 22 times more likely to die in their first year. When infants dying from congenital conditions were excluded, the differences in mortality rate ratios persisted for SGA infants, especially those born in the late preterm period. CONCLUSIONS Being SGA substantially increases the already higher mortality of late preterm and early term newborns. This increased risk cannot be fully explained by an increased prevalence of lethal congenital conditions among SGA late preterm newborns. Clinicians caring for late preterm and early term newborns should be cognizant of their WGA category.
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Affiliation(s)
- Laurie S Pulver
- Department of Pediatrics, University of Utah, Salt Lake City, UT 84158, USA.
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Abstract
"Late preterm" birth is not such an unusual occurrence; in fact these infants were the first group of premature infants who pediatricians learned to treat, and did so with such remarkable success that physicians no longer consider them to be of high risk. So, why the sudden interest in this group? There is now enough evidence that this population is not as benign as previously thought. They have increased mortality when compared to term infants and are at increased risk for complications including transient tachypnea of newborn (TTN), respiratory distress syndrome (RDS), persistent pulmonary hypertension (PPHN), respiratory failure, temperature instability, jaundice, feeding difficulties and prolonged neonatal intensive care unit (NICU) stay. Evidence is currently emerging that late preterm infants make up a majority of preterm births, take up significant resources, have increased mortality/morbidity, and may even have long-term neurodevelopmental consequences secondary to their late prematurity.
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Affiliation(s)
- Ashwin Ramachandrappa
- Department of Pediatrics, Division of Neonatology, Emory University School of Medicine, Atlanta, GA 30322, USA.
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Kayem G, Maillard F. Rupture prématurée des membranes avant terme : attitude interventionniste ou expectative ? ACTA ACUST UNITED AC 2009; 37:334-41. [DOI: 10.1016/j.gyobfe.2009.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2009] [Accepted: 03/04/2009] [Indexed: 01/20/2023]
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