The brainstem in late preterm birth: Born small-for-gestational-age is the “tip of the iceberg”

Introduction: Late preterm infants (LPIs) are infants born between 340/7 and 366/7 weeks gestation. Morbidities in these infants are commonly considered a result of prematurity; however, some research has suggested immaturity may not be the sole cause of morbidities. We hypothesize that antecedents leading to late preterm birth are associated with different patterns of morbidities and that morbidities are the result of gestational age superimposed by the underlying etiologies of preterm delivery. Methods: This is a retrospective cohort study of late preterm neonates born at a single tertiary care center. We examined neonatal morbidities including apnea of prematurity, hyperbilirubinemia, hypoglycemia, and the requirement for continuous positive airway pressure (CPAP). Multivariable logistic regression analysis was performed to estimate the risk of each morbidity associated with 3 categorized antecedents of delivery, that is, spontaneous preterm labor, preterm premature rupture of membranes (PPROM), and medically indicated birth. We calculated the predictive probability of each antecedent resulting in individual morbidity across gestational ages. Results: 279 LPIs were included in the study. Decreasing gestational age was associated with significantly increased risk of apnea of prematurity, hyperbilirubinemia, and requirement of CPAP. In our cohort, the risk of hypoglycemia increased with gestational age, with the greatest incidence at 360−6 weeks. There was no significant association of risk of selected morbidities and the antecedents of late preterm delivery, with or without adjustment for gestational age, multiple gestation, small for gestational age (SGA), antenatal steroids, and delivery method. Discussion and Conclusion: This study found no difference in morbidity risk related to 3 common antecedents of preterm birth in LPIs. Our research suggests that immaturity is the primary factor in determining adverse outcomes, intensified by factors resulting in prematurity.

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Changes in the Gestational Age Distribution among U.S. Singleton Births: Impact on Rates of Late Preterm Birth, 1992 to 2002

Seminars in Perinatology ◽

10.1053/j.semperi.2006.01.009 ◽

2006 ◽

Vol 30 (1) ◽

pp. 8-15 ◽

Cited By ~ 334

Author(s):

Michael J. Davidoff ◽

Todd Dias ◽

Karla Damus ◽

Rebecca Russell ◽

Vani R. Bettegowda ◽

...

Keyword(s):

Preterm Birth ◽

Gestational Age ◽

Age Distribution ◽

Late Preterm ◽

Late Preterm Birth

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Impact of gestational age on child intelligence, attention and executive function at age 5: a cohort study

BMJ Open ◽

10.1136/bmjopen-2019-028982 ◽

2019 ◽

Vol 9 (9) ◽

pp. e028982 ◽

Cited By ~ 2

Author(s):

Emilie Pi Fogtmann Sejer ◽

Frederik Jager Bruun ◽

Julie Anna Slavensky ◽

Erik Lykke Mortensen ◽

Ulrik Schiøler Kesmodel

Keyword(s):

Cohort Study ◽

Executive Function ◽

Preterm Birth ◽

Gestational Age ◽

Parental Education ◽

Mean Difference ◽

Late Preterm ◽

Late Preterm Birth ◽

The Mean ◽

The Impact

ObjectivesPreterm birth can affect cognition, but other factors including parental education and intelligence may also play a role, but few studies have adjusted for these potential confounders. We aimed to assess the impact of gestational age (GA), late preterm birth (34 to <37 weeks GA) and very to moderately preterm birth (<34 weeks GA) on intelligence, attention and executive function in a population of Danish children aged 5 years.DesignPopulation-based prospective cohort study.SettingDenmark 2003–2008.ParticipantsA cohort of 1776 children and their mothers sampled from the Danish National Birth Cohort with information on GA, family and background factors and completed neuropsychological assessment at age 5.Primary outcome measuresWechsler Preschool and Primary Scale of Intelligence-Revised, Test of Everyday Attention for Children at Five and Behaviour Rating Inventory of Executive Function scores.ResultsFor preterm birth <34 weeks GA (n=8), the mean difference in full-scale intelligence quotient(IQ) was −10.6 points (95% CI −19.4 to −1.8) when compared with the term group ≥37 weeks GA (n=1728), and adjusted for potential confounders. For the teacher-assessed Global Executive Composite, the mean difference was 5.3 points (95% CI 2.4 to 8.3) in the adjusted analysis, indicating more executive function difficulties in the preterm group <34 weeks GA compared with the term group. Maternal intelligence and parental education were weak confounders. No associations between late preterm birth 34 to <37 weeks GA (n=40) and poor cognition were shown.ConclusionsThis study showed substantially lower intelligence and poorer executive function in children born <34 weeks GA compared with children born at term. GA may play an important role in determining cognitive abilities independent of maternal intelligence and parental education. Studies with larger sample sizes are needed to confirm these findings, as the proportion of children born preterm in this study population was small.

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Preterm birth and subsequent timing of pubertal growth, menarche, and voice break

Pediatric Research ◽

10.1038/s41390-021-01690-5 ◽

2021 ◽

Author(s):

Julia Suikkanen ◽

Markku Nurhonen ◽

Tim J. Cole ◽

Marika Paalanne ◽

Hanna-Maria Matinolli ◽

...

Keyword(s):

Preterm Birth ◽

Gestational Age ◽

Small For Gestational Age ◽

Pubertal Timing ◽

Age Groups ◽

Late Preterm ◽

Height Velocity ◽

Age At Menarche ◽

Early Puberty ◽

Pubertal Growth

Abstract Background We evaluated pubertal growth and pubertal timing of participants born preterm compared to those born at term. Methods In the ESTER Preterm Birth Study, we collected growth data and measured final height of men/women born very or moderately preterm (<34 gestational weeks, n = 52/55), late preterm (34–<37 weeks, 94/106), and term (≥37 weeks, 131/151), resulting in median 9 measurements at ≥6 years. Timing of menarche or voice break was self-reported. Peak height velocity (PHV, cm/year) and age at PHV (years) were compared with SuperImposition by Translation And Rotation (SITAR) model (sexes separately). Results Age at PHV (years) and PHV (cm/year) were similar in all gestational age groups. Compared to term controls, insignificant differences in age at PHV were 0.1 (95% CI: −0.2 to 0.4) years/0.2 (−0.1 to 0.4) for very or moderately/late preterm born men and −0.0 (−0.3 to 0.3)/−0.0 (−0.3 to 0.2) for women, respectively. Being born small for gestational age was not associated with pubertal growth. Age at menarche or voice break was similar in all the gestational age groups. Conclusions Timing of pubertal growth and age at menarche or voice break were similar in participants born preterm and at term. Impact Pubertal growth and pubertal timing were similar in preterm and term participants in a relatively large cohort with a wide range of gestational ages. Previous literature indicates that small for gestational age is a risk for early puberty in term born children. This was not shown in preterm children. While our study had limited power for children born very preterm, all children born preterm were not at increased risk for early puberty.

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Association Between Features of Spontaneous Late Preterm Labor and Late Preterm Birth

American Journal of Perinatology ◽

10.1055/s-0039-1696641 ◽

2019 ◽

Vol 37 (04) ◽

pp. 357-364

Author(s):

Angelica V. Glover ◽

Ashley N. Battarbee ◽

Cynthia Gyamfi-Bannerman ◽

Kim A. Boggess ◽

Grecio Sandoval ◽

...

Keyword(s):

Preterm Birth ◽

Gestational Age ◽

Preterm Labor ◽

Secondary Analysis ◽

Area Under The Curve ◽

Late Preterm ◽

P Value ◽

Cervical Dilation ◽

Late Preterm Birth ◽

Gestational Age At Delivery

Abstract Objective This study aimed to evaluate the association between clinical and examination features at admission and late preterm birth. Study Design The present study is a secondary analysis of a randomized trial of singleton pregnancies at 340/7 to 365/7 weeks' gestation. We included women in spontaneous preterm labor with intact membranes and compared them by gestational age at delivery (preterm vs. term). We calculated a statistical cut-point optimizing the sensitivity and specificity of initial cervical dilation and effacement at predicting preterm birth and used multivariable regression to identify factors associated with late preterm delivery. Results A total of 431 out of 732 (59%) women delivered preterm. Cervical dilation ≥ 4 cm was 60% sensitive and 68% specific for late preterm birth. Cervical effacement ≥ 75% was 59% sensitive and 65% specific for late preterm birth. Earlier gestational age at randomization, nulliparity, and fetal malpresentation were associated with late preterm birth. The final regression model including clinical and examination features significantly improved late preterm birth prediction (81% sensitivity, 48% specificity, area under the curve = 0.72, 95% confidence interval [CI]: 0.68–0.75, and p-value < 0.01). Conclusion Four in 10 women in late-preterm labor subsequently delivered at term. Combination of examination and clinical features (including parity and gestational age) improved late-preterm birth prediction.

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66919 Third trimester electronic cigarette use and the risk of preterm birth, low birthweight, and small-for-gestational age

Journal of Clinical and Translational Science ◽

10.1017/cts.2021.714 ◽

2021 ◽

pp. 1-2

Author(s):

Lin Ammar ◽

Pingsheng Wu

Keyword(s):

Preterm Birth ◽

Gestational Age ◽

Small For Gestational Age ◽

Low Birthweight ◽

Electronic Cigarette ◽

Cigarette Use ◽

Third Trimester

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Small for Gestational Age Moderate to Late Preterm Children: A Neuropsychological Follow-up

Developmental Neuropsychology ◽

10.1080/87565641.2021.1939349 ◽

2021 ◽

pp. 1-11

Author(s):

Garazi Labayru ◽

Jone Aliri ◽

Andrea Santos ◽

Ane Arrizabalaga ◽

María Estevez ◽

...

Keyword(s):

Gestational Age ◽

Small For Gestational Age ◽

Late Preterm ◽

Preterm Children

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Maternal exposure to airborne polychlorinated biphenyls (PCBs) and risk of adverse birth outcomes

European Journal of Epidemiology ◽

10.1007/s10654-021-00793-x ◽

2021 ◽

Author(s):

Ane Bungum Kofoed ◽

Laura Deen ◽

Karin Sørig Hougaard ◽

Kajsa Ugelvig Petersen ◽

Harald William Meyer ◽

...

Keyword(s):

Birth Weight ◽

Preterm Birth ◽

Sex Ratio ◽

Polychlorinated Biphenyls ◽

Birth Outcomes ◽

Gestational Age ◽

Small For Gestational Age ◽

Maternal Exposure ◽

Adverse Birth Outcomes ◽

Secondary Sex Ratio

AbstractHuman health effects of airborne lower-chlorinated polychlorinated biphenyls (LC-PCBs) are largely unexplored. Since PCBs may cross the placenta, maternal exposure could potentially have negative consequences for fetal development. We aimed to determine if exposure to airborne PCB during pregnancy was associated with adverse birth outcomes. In this cohort study, exposed women had lived in PCB contaminated apartments at least one year during the 3.6 years before conception or the entire first trimester of pregnancy. The women and their children were followed for birth outcomes in Danish health registers. Logistic regression was performed to estimate odds ratios (OR) for changes in secondary sex ratio, preterm birth, major congenital malformations, cryptorchidism, and being born small for gestational age. We performed linear regression to estimate difference in birth weight among children of exposed and unexposed mothers. All models were adjusted for maternal age, educational level, ethnicity, and calendar time. We identified 885 exposed pregnancies and 3327 unexposed pregnancies. Relative to unexposed women, exposed women had OR 0.97 (95% CI 0.82, 1.15) for secondary sex ratio, OR 1.13 (95% CI 0.76, 1.67) for preterm birth, OR 1.28 (95% CI 0.81, 2.01) for having a child with major malformations, OR 1.73 (95% CI 1.01, 2.95) for cryptorchidism and OR 1.23 (95% CI 0.88, 1.72) for giving birth to a child born small for gestational age. The difference in birth weight for children of exposed compared to unexposed women was − 32 g (95% CI—79, 14). We observed an increased risk of cryptorchidism among boys after maternal airborne LC-PCB exposure, but due to the proxy measure of exposure, inability to perform dose–response analyses, and the lack of comparable literature, larger cohort studies with direct measures of exposure are needed to investigate the safety of airborne LC-PCB exposure during pregnancy

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