Gestational Age and Developmental Risk in Moderately and Late Preterm and Early Term Infants

Abstract Objectives Breast milk is the optimal source of infant nutrition. For the nearly 1 in 10 infants born prematurely in the United States annually, breast milk is especially beneficial, helping prevent sepsis and necrotizing enterocolitis (NEC) and promoting neurological development. Though the importance of breast milk for preterm infants has been established, national estimates of feeding practices by gestational age are unavailable. Our objective was to describe receipt of breast milk among preterm and term infants delivered in the United States in 2017. Methods Birth certificate data from 48 states and the District of Columbia (n = 3,194,873; 82.7% of all births) were analyzed to describe receipt of breast milk before birth certificate completion among extremely preterm (20-27 weeks), early preterm (28-33 weeks), late preterm (34-36 weeks) and term infants (≥ 37 weeks) with further stratification by maternal and infant characteristics. Results The prevalence of infants receiving breast milk was 83.9% overall and varied by gestational age: 71.3% (extremely preterm), 76.0% (early preterm), 77.3% (late preterm), and 84.6% (term). Disparities in receipt of breast milk by maternal race/ethnicity were noted across gestational ages. Infants delivered to black or American Indian/Alaska Native mothers were the least likely to have received breast milk while those delivered to white, Hispanic, and Asian mothers were more likely to have received breast milk. Differences in receipt of breast milk by other maternal sociodemographic factors also persisted similarly across gestational ages. Among late preterm and term infants, receipt of breast milk was lower for those admitted to the neonatal intensive care unit (NICU) than those not admitted to the NICU. Conclusions Fewer preterm than term infants received breast milk in the first few days of life. Optimal hospital policies and practices that support breast milk feeding and ensure availability of donor milk for high-risk infants may help improve infant nutrition and reduce infant morbidity and mortality. Mothers of infants admitted to the NICU may need additional support given the challenges associated with having a medically fragile infant such as mother-infant separation and extended infant hospitalization. Funding Sources Centers for Disease Control and Prevention, Oak Ridge Institute for Science and Education.

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Neonatal morbidity associated with late preterm and early term birth: the roles of gestational age and biological determinants of preterm birth

International Journal of Epidemiology ◽

10.1093/ije/dyt251 ◽

2013 ◽

Vol 43 (3) ◽

pp. 802-814 ◽

Cited By ~ 58

Author(s):

H. K. Brown ◽

K. N. Speechley ◽

J. Macnab ◽

R. Natale ◽

M. K. Campbell

Keyword(s):

Preterm Birth ◽

Gestational Age ◽

Neonatal Morbidity ◽

Late Preterm ◽

Term Birth ◽

Early Term ◽

Biological Determinants

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A late-preterm, early-term stratified analysis of neonatal outcomes by gestational age in placenta previa: defining the optimal timing for delivery

The Journal of Maternal-Fetal & Neonatal Medicine ◽

10.3109/14767058.2014.970529 ◽

2015 ◽

Vol 28 (15) ◽

pp. 1756-1761 ◽

Cited By ~ 7

Author(s):

Jacques Balayla ◽

Bi Lan Wo ◽

Marie-Josée Bédard

Keyword(s):

Gestational Age ◽

Placenta Previa ◽

Neonatal Outcomes ◽

Late Preterm ◽

Optimal Timing ◽

Early Term ◽

Stratified Analysis

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Latent iron deficiency at birth influences auditory neural maturation in late preterm and term infants

American Journal of Clinical Nutrition ◽

10.3945/ajcn.115.113084 ◽

2015 ◽

Vol 102 (5) ◽

pp. 1030-1034 ◽

Cited By ~ 21

Author(s):

Vivek Choudhury ◽

Sanjiv B Amin ◽

Asha Agarwal ◽

LM Srivastava ◽

Arun Soni ◽

...

Keyword(s):

Risk Factors ◽

Iron Deficiency ◽

Serum Ferritin ◽

Gestational Age ◽

Iron Status ◽

In Utero ◽

Late Preterm ◽

Term Infants ◽

Latent Iron Deficiency ◽

Neural Maturation

ABSTRACT Background: In utero latent iron deficiency has been associated with abnormal neurodevelopmental outcomes during childhood. Its concomitant effect on auditory neural maturation has not been well studied in late preterm and term infants. Objective: The objective was to determine whether in utero iron status is associated with auditory neural maturation in late preterm and term infants. Design: This prospective cohort study was performed at Sir Ganga Ram Hospital, New Delhi, India. Infants with a gestational age ≥34 wk were eligible unless they met the exclusion criteria: craniofacial anomalies, chromosomal disorders, hemolytic disease, multiple gestation, third-trimester maternal infection, chorioamnionitis, toxoplasmosis, other infections, rubella, cytomegalovirus infection, and herpes simplex virus infections (TORCH), Apgar score <5 at 5 min, sepsis, cord blood not collected, or auditory evaluation unable to be performed. Sixty consecutive infants with risk factors for iron deficiency, such as small for gestational age and maternal diabetes, and 30 without risk factors for iron deficiency were enrolled. Absolute wave latencies and interpeak latencies, evaluated by auditory brainstem response within 48 h after birth, were measured and compared between infants with latent iron deficiency (serum ferritin ≤75 ng/mL) and infants with normal iron status (serum ferritin >75 ng/mL) at birth. Results: Twenty-three infants had latent iron deficiency. Infants with latent iron deficiency had significantly prolonged wave V latencies (7.10 ± 0.68 compared with 6.60 ± 0.66), III–V interpeak latencies (2.37 ± 0.64 compared with 2.07 ± 0.33), and I–V interpeak latencies (5.10 ± 0.57 compared with 4.72 ± 0.56) compared with infants with normal iron status (P < 0.05). This difference remained significant on regression analyses after control for confounders. No difference was noted between latencies I and III and interpeak latencies I–III. Conclusion: Latent iron deficiency is associated with abnormal auditory neural maturation in infants at ≥34 wk gestational age. This trial was registered at clinicaltrials.gov as NCT02503397.

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