1
|
Paes LS, Carvalho FH, Araujo Júnior E, Feitosa HN. Assessment of morbidity and mortality in newborns with late prematurity: experience of a reference maternity in the northeast of Brazil. Minerva Obstet Gynecol 2021; 74:270-278. [PMID: 33876899 DOI: 10.23736/s2724-606x.21.04734-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Late preterm infants show high rates of adverse perinatal outcomes. The aim of this study is to assess the morbidity and mortality of newborns (NBs) with late preterm birth in a reference maternity hospital in northeastern Brazil. METHODS Retrospective cohort study from March 1 to July 15, 2017. A total of 204 NBs with gestational age between 34 and 36 weeks and six days were evaluated and compared to 205 full-term NBs (39 and 40 weeks and six days). Perinatal outcomes including neonatal morbidity were evaluated. The Student's t and ANOVA tests were used for normal variables, and the Wilcoxon, Mann-Whitney and Kruskal-Wallis tests for non-normal variables. RESULTS Late preterm infants showed significant higher rates of hypothermia, hypoglycemia, respiratory distress syndrome, jaundice in need of phototherapy (67.6%), admission to the neonatal intensive care unit (ICU), and difficulty breastfeeding compared to full-term NBs (p<0.001). Respiratory distress was the main indication for the admission of late preterm infants (p<0.001) to neonatal ICU. Late preterm infants had a longer hospital stay (6.9 vs. 3.7 days, p<0.001). There were three deaths in the group of late preterm NBs, and none in the group of term NBs. CONCLUSIONS Late preterm NBs presented higher rates of morbidity and mortality when compared to full-term NBs.
Collapse
Affiliation(s)
- Liliana S Paes
- Department of Maternal and Child Health, Federal University of Ceará (UFC), Fortaleza-CE, Brazil
| | - Francisco H Carvalho
- Department of Maternal and Child Health, Federal University of Ceará (UFC), Fortaleza-CE, Brazil
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine, Federal University of São Paulo (EPM-UNIFESP), São Paulo-SP, Brazil -
| | - Helvécio N Feitosa
- Department of Maternal and Child Health, Federal University of Ceará (UFC), Fortaleza-CE, Brazil
| |
Collapse
|
2
|
Aliaga S, Zhang J, Long DL, Herring AH, Laughon M, Boggess K, Reddy UM, Grantz KL. Center Variation in the Delivery of Indicated Late Preterm Births. Am J Perinatol 2016; 33:1008-16. [PMID: 27120474 PMCID: PMC4972671 DOI: 10.1055/s-0036-1582129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Objective Evidence for optimal timing of delivery for some pregnancy complications at late preterm gestation is limited. The purpose of this study was to identify center variation of indicated late preterm births. Study design We performed an analysis of singleton late preterm and term births from a large U.S. retrospective obstetrical cohort. Births associated with spontaneous preterm labor, major congenital anomalies, chorioamnionitis, and emergency cesarean were excluded. We used modified Poisson fixed effects logistic regression with interaction terms to assess center variation of indicated late preterm births associated with four medical/obstetric comorbidities after adjusting for socio-demographics, comorbidities, and hospital/provider characteristics. Results We identified 150,055 births from 16 hospitals; 9,218 were indicated late preterm births. We found wide variation of indicated late preterm births across hospitals. The extent of center variation was greater for births associated with preterm premature rupture of membranes (risk ratio [RR] across sites: 0.45-3.05), hypertensive disorders of pregnancy (RR across sites: 0.36-1.27), and placenta previa/abruption (RR across sites: 0.48-1.82). We found less center variation for births associated with diabetes (RR across sites: 0.65-1.39). Conclusion Practice variation in the management of indicated late preterm deliveries might be a source of preventable late preterm birth.
Collapse
Affiliation(s)
- Sofia Aliaga
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC, Pediatrics CB#7596, 101 Manning Drive, Chapel Hill, NC 27599; ;
| | - Jun Zhang
- MOE-Shanghai Key Laboratory of Children’s Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, 800 Dongchuan Rd., Minhang District, Shanghai, China;
| | - D. Leann Long
- Department of Biostatistics, West Virginia University, PO Box 9190, Morgantown, WV 26506;
| | - Amy H. Herring
- Department of Biostatistics, West Virginia University, PO Box 9190, Morgantown, WV 26506;
- Carolina Population Center, 206 West Franklin St., Rm. 208, Chapel Hill, NC 27516;
| | - Matthew Laughon
- Department of Pediatrics, University of North Carolina, Chapel Hill, NC, Pediatrics CB#7596, 101 Manning Drive, Chapel Hill, NC 27599; ;
| | - Kim Boggess
- Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, The University of North Carolina, 101 Manning Drive, CB #7516, Old Clinic Building, Chapel Hill, NC 27599;
| | - Uma M. Reddy
- Pregnancy and Perinatology Branch, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, 6100 Executive Blvd Room 7B03M, MSC 7510, Bethesda, MD 20852;
| | - Katherine Laughon Grantz
- Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, 6100 Executive Blvd Room 7B03M, MSC 7510, Bethesda, MD 20852;
| |
Collapse
|
3
|
Davies EL, Bell JS, Bhattacharya S. Preeclampsia and preterm delivery: A population-based case-control study. Hypertens Pregnancy 2016; 35:510-519. [PMID: 27322489 DOI: 10.1080/10641955.2016.1190846] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To determine the contribution of preeclampsia toward preterm birth in primiparous women. METHODS This large population-based case-control study used the Aberdeen Maternity and Neonatal Databank to analyze data on primiparous women with singleton pregnancies, who delivered between 1997 and 2012. RESULTS A significant positive association was found between preeclampsia and preterm birth (adjusted odds ratio 4.43; 95% confidence interval 3.80-5.16). Magnitude of association varied according to the onset of delivery and year of delivery. CONCLUSION Preeclampsia is an important contributor to preterm delivery in this setting and therefore a potentially useful condition to target in order to reduce preterm rates.
Collapse
Affiliation(s)
- Emma L Davies
- a Public Health, Summerfield House , NHS Grampian , Aberdeen , Scotland , UK
| | - Jacqueline S Bell
- a Public Health, Summerfield House , NHS Grampian , Aberdeen , Scotland , UK.,b Immpact, School of Medicine and Dentistry , University of Aberdeen , Aberdeen , Scotland , UK
| | - Sohinee Bhattacharya
- c Obstetric Epidemiology , Dugald Baird Centre for Research on Women's Health, Aberdeen Maternity Hospital , Aberdeen , Scotland , UK
| |
Collapse
|
4
|
Boyle EM, Johnson S, Manktelow B, Seaton SE, Draper ES, Smith LK, Dorling J, Marlow N, Petrou S, Field DJ. Neonatal outcomes and delivery of care for infants born late preterm or moderately preterm: a prospective population-based study. Arch Dis Child Fetal Neonatal Ed 2015; 100:F479-85. [PMID: 25834169 PMCID: PMC4680176 DOI: 10.1136/archdischild-2014-307347] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 12/23/2014] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe neonatal outcomes and explore variation in delivery of care for infants born late (34-36 weeks) and moderately (32-33 weeks) preterm (LMPT). DESIGN/SETTING Prospective population-based study comprising births in four major maternity centres, one midwifery-led unit and at home between September 2009 and December 2010. Data were obtained from maternal and neonatal records. PARTICIPANTS All LMPT infants were eligible. A random sample of term-born infants (≥37 weeks) acted as controls. OUTCOME MEASURES Neonatal unit (NNU) admission, respiratory and nutritional support, neonatal morbidities, investigations, length of stay and postnatal ward care were measured. Differences between centres were explored. RESULTS 1146 (83%) LMPT and 1258 (79% of eligible) term-born infants were recruited. LMPT infants were significantly more likely to receive resuscitation at birth (17.5% vs 7.4%), respiratory (11.8% vs 0.9%) and nutritional support (3.5% vs 0.3%) and were less likely to be fed breast milk (64.2% vs 72.2%) than term infants. For all interventions and morbidities, a gradient of increasing risk with decreasing gestation was evident. Although 60% of late preterm infants were never admitted to a NNU, 83% required medical input on postnatal wards. Clinical management differed significantly between services. CONCLUSIONS LMPT infants place high demands on specialist neonatal services. A substantial amount of previously unreported specialist input is provided in postnatal wards, beyond normal newborn care. Appropriate expertise and planning of early care are essential if such infants are managed away from specialised neonatal settings. Further research is required to clarify optimal and cost-effective postnatal management for LMPT babies.
Collapse
Affiliation(s)
- Elaine M Boyle
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Samantha Johnson
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Bradley Manktelow
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Sarah E Seaton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | | | - Lucy K Smith
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Jon Dorling
- Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - Neil Marlow
- UCL EGA Institute for Women's Health, London, UK
| | - Stavros Petrou
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - David J Field
- Department of Health Sciences, University of Leicester, Leicester, UK
| |
Collapse
|
5
|
Kitsommart R, Phatihattakorn C, Pornladnun P, Paes B. A prospective study of the severity of early respiratory distress in late preterms compared to term infants. J Matern Fetal Neonatal Med 2014; 29:207-12. [DOI: 10.3109/14767058.2014.992335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Ratchada Kitsommart
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand,
| | - Chayawat Phatihattakorn
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand, and
| | - Pornpat Pornladnun
- Division of Neonatology, Department of Pediatrics, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand,
| | - Bosco Paes
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
6
|
Moreira MEL, Gama SGND, Pereira APE, Silva AAMD, Lansky S, Pinheiro RDS, Gonçalves ADC, Leal MDC. Práticas de atenção hospitalar ao recém-nascido saudável no Brasil. CAD SAUDE PUBLICA 2014; 30 Suppl 1:S1-12. [DOI: 10.1590/0102-311x00145213] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2013] [Accepted: 03/28/2014] [Indexed: 11/22/2022] Open
Abstract
O objetivo do estudo foi avaliar o cuidado ao recém-nascido saudável a termo e identificar variações nesse cuidado no atendimento ao parto e na primeira hora de vida. Utilizou-se a base de dados da pesquisa Nascer no Brasil. Foram estimadas as razões de produtos cruzados OR brutas e ajustadas entre as características do hospital, maternas e de assistência ao parto com os desfechos: aspiração de vias aéreas e gástrica, uso do oxigênio inalatório, uso de incubadora, contato pele a pele, alojamento conjunto e oferta do seio materno na sala de parto e na primeira hora de vida. Foi observada grande variação das práticas usadas na assistência ao recém-nascido a termo na sala de parto. Práticas consideradas inadequadas como uso de oxigênio inalatório (9,5%), aspiração de vias aéreas (71,1%) e gástrica (39,7%) e uso de incubadora (8,8%) foram excessivamente usadas. A ida ao seio na sala de parto foi considerada baixa (16,1%), mesmo nos hospitais com título de Hospital Amigo da Criança (24%). Esses resultados sugerem baixos níveis de conhecimento e aderência às boas práticas clínicas.
Collapse
Affiliation(s)
| | | | | | | | - Sônia Lansky
- Secretaria Municipal de Saúde de Belo Horizonte, Brasil
| | | | | | | |
Collapse
|
7
|
Bonney EA. Demystifying animal models of adverse pregnancy outcomes: touching bench and bedside. Am J Reprod Immunol 2013; 69:567-84. [PMID: 23448345 DOI: 10.1111/aji.12102] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2013] [Accepted: 01/28/2013] [Indexed: 01/21/2023] Open
Abstract
This represents an overview of the use of animal models to study the adverse pregnancy outcomes seen in humans. The purpose is to entice clinicians to utilize some of this information to seek out the literature and have more meaningful and profitable discussions with their academic colleagues and enhance transdisciplinary research in reproductive health.
Collapse
Affiliation(s)
- Elizabeth A Bonney
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Vermont College of Medicine, Burlington, VT, USA.
| |
Collapse
|