Childhood Respiratory Morbidity after Late Preterm and Early Term Delivery: a Study of Medicaid Patients in South Carolina

Mechanical atrioventricular valve replacement in patients with single ventricle palliation

OBJECTIVES

Atrioventricular valve (AVV) replacements in patients with single-ventricle circulations pose significant surgical risks and are associated with high morbidity and mortality.

METHODS

From 1997 to 2021, 16 consecutive patients with functionally single-ventricle physiology underwent mechanical AVV replacement. Primary outcome was transplant-free survival. Secondary outcomes included major postoperative morbidity.

RESULTS

The median age of AVV replacement was 2 years old (interquartile range 0.6-3.8 years). All AVV replacements were performed with a St. Jude Medical mechanical valve, median 24 mm (range, 19-31mm). Extracorporeal membrane oxygenation (ECMO) was required in 4 patients. Operative mortality was 38% (6/16). There were 2 late deaths and 3 transplants. Transplant-free survival was 50% at 1 year, 37.5% at 5 years, and 22% at 10 years. Transplant-free survival was higher for patients with preserved ventricular function (P = 0.01). Difference in transplant-free survival at 1 year was 75% vs 25%, at 5 years was 62.5% vs 12.5% and at 10 years was 57% vs 0%. Three (19%) patients had complete heart block requiring permanent pacemaker insertion. 6 of 13 patients (46%) patients reached Fontan completion (3 patients operated at/after Fontan). Significant bleeding events occurred in 8 patients (50%) with 3 patients suffering major cerebrovascular accidents. There were 6 events of valve thrombosis in 5 patients, resulting in 2 deaths and 2 heart transplants.

CONCLUSIONS

Mechanical valve replacement carries significant morbidity and mortality risk. While it successfully salvages about half of patients with preserved ventricular function, careful consideration of alternative options should be made before embarking upon mechanical valve replacement.

Impact of early term and late preterm birth on infants' neurodevelopment: evidence from a cohort study in Wuhan, China

Background

The incidences of early term and late preterm birth have increased worldwide during recent years. However, there is a lack of prospective study about the influence of early term and late preterm birth on infants’ neurodevelopment, especially at the early stage. Therefore, we conducted this cohort study to investigate the impact of early term and late preterm birth on infants’ neurodevelopment within 6 months.

Methods

This cohort study was conducted in Wuhan, China, between October 2012 and September 2013. A total of 4243 singleton infants born within 34-41 weeks of gestation at Wuhan Children’s Hospital were included. The Gesell Developmental Scale (GDS) was utilized to evaluate the neurodevelopment of infants.

Results

Among the 4243 included participants, 155 (3.65%) were late preterm infants, 1288 (30.36%) were early term infants, and 2800 (65.99%) were full term infants. After adjusted for potential confounders, significant negative relationship was shown between late preterm birth and development quotient (DQ) in all domains of neurodevelopment: gross motor (β = − 17.42, 95% CI: − 21.15 to − 13.69), fine motor (β = − 23.61, 95% CI: − 28.52 to − 18.69), adaptability (β = − 10.10, 95% CI: − 13.82 to − 6.38), language (β = − 6.28, 95% CI: − 9.82 to − 2.74) and social behavior (β = − 5.99, 95% CI: − 9.59 to − 2.39). There was a significant negative trend for early term birth in DQ of fine motor (β = − 2.01, 95% CI: − 3.93 to − 0.09). Late preterm infants had a significantly elevated risk of neurodevelopmental delay in domains of gross motor (adjusted OR = 3.82, 95% CI: 2.67 to 5.46), fine motor (adjusted OR = 3.51, 95% CI: 2.47 to 5.01), and adaptability (adjusted OR = 1.60, 95% CI: 1.12 to 2.29), whereas early term birth was significantly associated with neurodevelopmental delay of fine motor (adjusted OR = 1.22, 95% CI: 1.05 to 1.42).

Conclusions

This study suggested that late preterm birth mainly elevated the risk of neurodevelopmental delay of gross motor, fine motor, and adaptability, whereas early term birth was associated with the developmental delay of fine motor within 6 months. Further research is needed to determine the effectiveness and necessity of the interventions at the early stage for early term and late preterm infants who had suspected neurodevelopmental delay.

nnLong-Term Respiratory Outcomes in Early Term Born Offspring: A Systematic Review and Meta-Analysis

OBJECTIVE

Newborns exhibit the lowest immediate respiratory morbidity rates when born at full term (39-40) completed weeks of gestation. We evaluated whether early-term deliveries (37^0/7-38^6/7 weeks of gestation) bare a significant impact on overall and specific long-term respiratory outcomes of offspring up to the age of 18 years, as compared to offspring born at full term or later.

DATA SOURCES

PubMed/Medline, EMBASE, and relevant reference lists from January 2012 to May 2020.

STUDY ELIGIBILITY CRITERIA

This systematic review and meta-analysis was conducted according to the PRISMA guidelines and was registered in PROSPERO. Any observational or randomized human trials addressing the association between early term delivery and long-term respiratory outcomes in the offspring, restricted to studies published in English, were included. Search included terms relating to gestational age, pediatric morbidity, and respiratory outcomes. We included studies assessing long term respiratory disease (1-18 years) of offspring born during early term as compared to full term and later.

STUDY APPRAISAL AND SYNTHESIS METHODS

Two independent reviewers extracted data and assessed risk of bias. Using a random-effect meta-analysis, pooled relative risk with their 95% confidence intervals and heterogeneity were determined. Publication bias was assessed by Funnel plots with Eggers regression line and contours, and sensitivity analyses were performed using Baujat plots.

RESULTS

Fourteen studies were included following a screen of nearly 2500 abstracts. These studies included nearly eight million patients, and were subjected to qualitative and quantitative analyses. Early term delivery significantly increased the risk of total respiratory morbidity in the offspring (RR= 1.20, 95% CI= 1.16, 1.26) as compared to full term delivery. The increased respiratory morbidity was attributed to obstructive airway diseases (RR=1.19, 95% CI= 1.12, 1.27) and infectious respiratory diseases (RR= 1.22, 95% CI= 1.17, 1.29). Most studies were of acceptable quality.

CONCLUSION

This comprehensive meta-analysis suggests that early term delivery poses a risk for long term pediatric respiratory morbidity, as compared to full term delivery. Notably, other factors over the years cannot be accounted for. This adds an important perspective to be considered when balancing the fetal, maternal, and neonatal risks associated with delivery timing.

Association between early-term birth and delayed neurodevelopment at the age of 2 years: results from a cohort study in China

A growing body of evidence indicates that early-term births (37-38 weeks of gestational age) have an increased risk of short-term and long-term complications. Here, we sought to explore the association between early-term births and the risk of delayed neurodevelopment at age 2 years. Pregnant women and their live singleton birth were recruited from a single tertiary hospital between October 2013 and February 2017. Mental and Psychomotor Development Indexes (MDI and PDI) were assessed using the Bayley Scales of Infant Development (BSID). Delayed neurodevelopment was defined as scores of PDI or MDI less than -1SD relative to the mean score of the study population. In total, 1678 full-term infants and 727 early-term infants were assessed when they were 2 years old. After adjustment for potential confounders, early-term birth was related to 43% increased odds of neurodevelopmental delay in the PDI domain as compared with full-term birth (OR: 1.43; 95% CI: 1.12, 1.82). The observed associations were more prominent among those infants born by cesarean (OR: 1.44; 95% CI: 1.03, 2.00) and among males (OR: 1.66; 95% CI: 1.20, 2.28). No statistical difference in the MDI domain was found between early-term and full-term births.Conclusions: Our findings suggest that early-term birth was associated with increased odds of delayed neurodevelopment in the PDI domain as measured by BSID assessments at age 2 years. Health professionals should be aware of the influence of early-term birth on the risk of delayed neurodevelopment. What is Known: • Evidence indicates that early-term births have an increased risk of short-term and long-term complications. • The association between early-term births and delayed neurodevelopment at their early childhood has not been widely studied. What is New: • Early-term birth was associated with increased odds of delayed neurodevelopment in PDI domain as measured by BSID assessments at age 2 years. • The observed associations were more prominent among infants born by cesarean section and among male infants.

Respiratory morbidity, atopy and asthma at school age in preterm infants aged 32-35 weeks

Little is known about respiratory morbidity and asthma risk in preterm infants (PTIs) with a gestational age (GA) over 32 weeks. This was a prospective study carried out from birth to 7-8 years, comparing two groups: (a) PTIs (GAs 32 weeks + 1 day to 35 weeks + 0 days, without comorbidities) and (b) full-term infants (FTIs; GA ≥ 37 weeks). Risk and protective factors for bronchiolitis and asthma were identified. A total of 232 children (116/group) were included. Sixty-six (56.9%) PTIs and 43 (37.1%) FTIs presented bronchiolitis (p = 0.002). Recurrent wheezing was 52 (44.8%) on PTIs versus 36 (31.0%) on FTIs (p = 0.03). Asthma at school aged was 27 (23.3%) on PTIs and 8 (6.9%) on FTIs (p = 0.020). Asthma risk factors were only detected in group A.Conclusion: PTIs had a higher prevalence of bronchiolitis, recurrent wheezing and asthma; risk factors for asthma are the following: older siblings, allergic father, atopic dermatitis and antibiotic treatment in the first 3 years of life and prematurity itself, which also acted as protective factor for atopic dermatitis. What is known: • In recent decades, there has been a significant increase in the birth of premature babies and consequently, also in the pathologies secondary to the prematurity: a greater number of complications and disorders related to the development and maturation of many organs and systems, especially the respiratory system. Several studies, especially in full-term infants and very preterm infants, have tried to elucidate the risk factors that may influence the development of persistent or chronic respiratory problems such asasthma, but little is known about the aetiology of these disorders in the late or moderate preterm infants. Inthis group of children, the role played by certain factors (early use of antibiotics, chorioamnionitis, smokeexposure, paternal asthma, etc.) on late respiratory morbidity, or asthma, is inconclusive. • Moderate-to-late preterm infants are more predisposed to developing recurrent wheezing/asthma and should adopt control measures. What is new: • Our work provides data related to little-understood aspects of respiratory diseases in this group of late or moderate preterm infants (gestational age between 32 weeks plus 1 day and 35 weeks plus 0 days), by monitoring their evolution from birth to 7-8 years of age, compared with another group of full-term newborns. We aimed to establish the prevalence of bronchiolitis and recurrent wheezing in these children during their first years of life. • The prevalence of school-aged asthma and the risk factors for contracting it were also investigated.

Epidemiology of late preterm and early term births - An international perspective

Late preterm (34-36 weeks of gestational age (GA)), and early term (37-38 weeks GA) birth rates among singleton live births vary from 3% to 6% and from 15% to 31%, respectively, across countries, although data from low- and middle-income countries are sparse. Countries with high preterm birth rates are more likely to have high early term birth rates; many risk factors are shared, including pregnancy complications (hypertension, diabetes), medical practices (provider-initiated delivery, assisted reproduction), maternal socio-demographic and lifestyle characteristics and environmental factors. Exceptions include nulliparity and inflammation which increase risks for preterm, but not early term birth. Birth before 39 weeks GA is associated with adverse child health outcomes across a wide range of settings. International rate variations suggest that reductions in early delivery are achievable; implementation of best practice guidelines for obstetrical interventions and public health policies targeting population risk factors could contribute to prevention of both late preterm and early term births.

Associations of gestational age with child health and neurodevelopment among twins: A nationwide Japanese population-based study

BACKGROUND

The prevalence of multiple births has recently increased. However, the association between gestational age and long-term morbidity among twins remains unclear.

AIMS

To examine the association of gestational age with child health and neurological development in early childhood among twins.

STUDY DESIGN

Population-based longitudinal study.

SUBJECTS

We included 947 children from 479 pairs of twins with information on gestational age.

OUTCOME MEASURES

Hospitalization was used as an indicator of physical health, and responses to questions about age-appropriate behaviors were used as an indicator of neurobehavioral development. We conducted binomial log-linear regression analyses, controlling for both child and maternal variables in the model. We accounted for correlations within the pairs with generalized estimating equations.

RESULTS

The early term group (i.e., 37 to 38 weeks of gestation) had a lower risk of poor child health and unfavorable neurodevelopment compared with the full term group (≥39 weeks of gestation) and preterm group (<37 weeks of gestation). Compared with the early term group, the adjusted risk ratios for hospitalization for all causes during the period from 7 to 18 months of age was 2.2 (95% confidence interval: 1.3-3.8) for very preterm children (<32 weeks of gestation), 1.1 (0.8-1.6) for moderately and late preterm children (32 to 36 weeks of gestation), and 1.8 (1.0-3.2) for full term children.

CONCLUSION

We observed a U-shaped association of gestational age with child health and neurodevelopment. The early term group had the lowest risk of poor outcomes among twins.

Contemporary Outcomes and Factors Associated With Mortality After a Fetal or Postnatal Diagnosis of Common Arterial Trunk

BACKGROUND

Common arterial trunk (CAT) is a rare anomaly with a spectrum of pathology. We sought to identify current trends and factors associated with postnatal outcomes.

METHODS

This was a single-centre review including 153 live births with planned surgery. Patients were analyzed as 2 cohorts based on era of CAT diagnosis (1990 to 1999 vs 2000 to 2014) and complexity of disease (simple vs complex). "Complex" required the association with significant aortic arch obstruction, truncal valve (TV) stenosis/regurgitation, and/or branch pulmonary artery (PA) hypoplasia, respectively.

RESULTS

Sixteen (10%) died preoperatively, and this outcome was associated with significant TV stenosis (odds ratio [OR] 4.55; P = 0.01) and regurgitation (OR 3.17; P = 0.04); 130 (95%) of 137 operated infants underwent primary complete repair. Their survival rates to 1 year improved from 54% to 85% after 2000, although this outcome remained substantially lower for cases with a complex vs simple CAT repair (76% vs 95%; OR 6.46; P = 0.006). Other risk factors associated with decreased 1-year survival included diagnosis before 2000 (OR 4.48; P = 0.038) and a lower birth weight (OR 8.0 per kg weight; P = 0.001). Finally, of 93 survivors beyond year 1 of life, 76 (82%) had undergone a total of 224 reinterventions. Only 15 (16%) were alive without any surgical or catheter-based reintervention at study end.

CONCLUSIONS

Despite recent surgical improvements, postnatal mortality continues to be substantial if CAT is complicated by significant pathology of the TV, aortic arch, or branch PAs. Reoperations and catheter interventions are eventualities for most patients during childhood.

Impact of maternal thyroid autoantibodies positivity on the risk of early term birth: Ma'anshan Birth Cohort Study

PURPOSE

We aim to investigate associations of maternal serum anti-thyroperoxidase autoantibody (TPOAb) with duration of gestation. We aim to investigate whether maternal TPOAb positivity is associated with the risk of premature or early term birth.

METHODS

This was a prospective birth cohort study performed in an iodine sufficient area of China. Serum samples were collected from 2931 women at both the first and second trimesters of pregnancy. Thyrotropin (TSH), free thyroxine (FT4), and TPOAb levels were measured. Data on gestational age at birth was obtained from delivery records.

RESULTS

The prevalence of early term birth was 23.8%, while the prevalence of premature birth was 4.2%. The prevalence of TPOAb positivity was 12.1% in the first trimester and was 7.2% in the second trimester. Gestational age at birth was inversely associated with lgTPOAb both in the first trimester (β, -0.283, 95% CI -0.408, -0.158; P < 0.001) and in the second trimester (β, -0.174, 95% CI -0.319, -0.030; P = 0.018), after adjustment for potential confounding factors. There was a positive association of TPOAb positivity with the risk of early term birth both in the first (OR = 1.691, 95% CI 1.302, 2.197) and second trimesters (OR = 1.644, 95% CI 1.193, 2.264), after adjustment for potential confounding factors. TPOAb positivity in the second trimester was associated with a 1.863-fold higher risk of premature birth (OR = 1.863, 95% CI 1.009, 3.441), after adjustment for potential confounding factors.

CONCLUSIONS

Our results show that TPOAb is associated with shorter duration of gestation and with higher risk of premature and early term birth.

Health Services Use by Late Preterm and Term Infants From Infancy to Adulthood: A Meta-analysis

CONTEXT

Late-preterm infants born at 34 to 36 weeks' gestation have increased risks of various health problems. Health service utilization (HSU) of late-preterm infants has not been systematically summarized before.

OBJECTIVES

To summarize the published literature on short- and long-term HSU by late-preterm infants versus term infants from infancy to adulthood after initial discharge from the hospital.

DATA SOURCES

We searched Medline, Embase, the Cumulative Index to Nursing and Allied Health Literature, and PsycINFO.

STUDY SELECTION

Cohort and case-control studies that compared HSU (admissions, emergency department visits, etc) between late-preterm infants and term infants were included.

DATA EXTRACTION

Data extracted included study design, setting, population, HSU, covariates, and effect estimates.

RESULTS

Fifty-two articles were included (50 cohort and 2 case-control studies). Meta-analyses with random effect models that used the inverse-variance method found that late-preterm infants had higher chances of all-cause admissions than term infants during all the time periods. The magnitude of the differences decreased with age from the neonatal period through adolescence, with adjusted odds ratios from 2.34 (95% confidence intervals 1.19-4.61) to 1.09 (1.05-1.13) and adjusted incidence rate ratios from 2.62 (2.52-2.72) to 1.14 (1.11-1.18). Late-preterm infants had higher rates of various cause-specific HSU than term infants for jaundice, infection, respiratory problems, asthma, and neurologic and/or mental health problems during certain periods, including adulthood.

LIMITATIONS

Considerable heterogeneity existed and was partially explained by the variations in the adjustment for multiple births and gestational age ranges of the term infants.

CONCLUSIONS

Late-preterm infants had higher risks for all-cause admissions as well as for various cause-specific HSU during the neonatal period through adolescence.

Design, Implementation, and Early Outcome Indicators of a New Family-Integrated Neonatal Unit

Neonatal units are becoming more family-centered based on evidence of improved health outcomes when parents provide care to newborns. Physical environment constraints, as well as nursing care traditions and practices, have been barriers to providing care that includes close parental involvement. Our hospital's experience in implementing a unique model of family-centered care in a Level II nursery suggests that this model of care is beneficial to families, satisfying to health care providers, and a viable model for practice. Some basic outcome data are discussed along with suggestions for future research.

What accounts for the association between late preterm births and risk of asthma?

BACKGROUND

Although results of many studies have indicated an increased risk of asthma in former late preterm (LPT) infants, most of these studies did not fully address covariate imbalance.

OBJECTIVE

To compare the cumulative frequency of asthma in a population-based cohort of former LPT infants to that of matched term infants in their early childhood, when accounting for covariate imbalance.

METHODS

From a population-based birth cohort of children born 2002-2006 in Olmsted County, Minnesota, we assessed a random sample of LPT (34 to 36 6/7 weeks) and frequency-matched term (37 to 40 6/7 weeks) infants. The subjects were followed-up through 2010 or censored based on the last date of contact, with the asthma status based on predetermined criteria. The Kaplan-Meier method was used to estimate the cumulative incidence of asthma during the study period. Cox models were used to estimate the hazard ratio and 95% confidence interval for the risk of asthma, when adjusting for potential confounders.

RESULTS

LPT infants (n = 282) had a higher cumulative frequency of asthma than did term infants (n = 297), 29.9 versus 19.5%, respectively; p = 0.01. After adjusting for covariates associated with the risk of asthma, an LPT birth was not associated with a risk of asthma, whereas maternal smoking during pregnancy was associated with a risk of asthma.

CONCLUSION

LPT birth was not independently associated with a risk of asthma and other atopic conditions. Clinicians should make an effort to reduce exposure to smoking during pregnancy as a modifiable risk factor for asthma.