Comparison of determinants of morbidities of late preterms and terms

Background: To compare the determinants of neonatal morbidity in late preterms and terms.Methods: A total of 100 live late preterm (34-0/7 to 36-6/7 weeks) and 100 term infants (37-0/7 to 41-6/7 weeks) admitted in sri guru ram das institute of medical sciences and research were randomly selected to participate in this case control study. The study group include 100 neonates within gestation age of 34 0/7 to 36 6/7 weeks. Equal number of terms between 37 0/7 to 41-6/7 gestation age was taken for comparison. The maternal history including both antenatal and natal history as well as new-born profile was taken.Results: Maternal risk factors have been found to be the major determinants of morbidity in late preterms with PROM (p<0.0001), sepsis and hypertension being significant contributors. Respiratory distress, neonatal jaundice, sepsis has been found to be major morbidity factors in late preterms. The average duration of admission was higher in late preterms than terms.Conclusions: Late preterm infants have higher risks for acute metabolic complications, mortality and long-term disabilities as compared to term infants. Morbidities like respiratory distress, neonatal jaundice, sepsis, hypoglycaemia and hypothermia are more in late preterms due to their immaturity. The risks associated with late preterm birth suggest the need for refinement of obstetric paradigms to extend pregnancy duration if benefits outweigh risk to fetus and mother. There is need to make obstetricians and families aware of complications pertaining to late preterm birth and improving surveillance of high-risk pregnancies.

Download Full-text

206: Does antenatal corticosteroids treatment in twin pregnancies prior to late preterm birth reduce neonatal morbidity?

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2019.11.222 ◽

2020 ◽

Vol 222 (1) ◽

pp. S142-S143

Author(s):

Alon Ben-David ◽

Rita Zlatkin ◽

Shiran Bookstein-Peretz ◽

Raanan Meyer ◽

Shali Mazaki-Tovi ◽

...

Keyword(s):

Preterm Birth ◽

Neonatal Morbidity ◽

Late Preterm ◽

Antenatal Corticosteroids ◽

Late Preterm Birth ◽

Twin Pregnancies

Download Full-text

Effect of late preterm birth on neonatal morbidity risk

Early Human Development ◽

10.1016/j.earlhumdev.2008.09.090 ◽

2008 ◽

Vol 84 ◽

pp. S36

Author(s):

Edina Flach ◽

Simone Funke ◽

Ilona Sarkany ◽

Gabriella Vida ◽

Judit Gyarmati ◽

...

Keyword(s):

Preterm Birth ◽

Neonatal Morbidity ◽

Late Preterm ◽

Late Preterm Birth ◽

Morbidity Risk

Download Full-text

Does antenatal steroids treatment in twin pregnancies prior to late preterm birth reduce neonatal morbidity? Evidence from a retrospective cohort study

Archives of Gynecology and Obstetrics ◽

10.1007/s00404-020-05709-w ◽

2020 ◽

Vol 302 (5) ◽

pp. 1121-1126

Author(s):

Alon Ben-David ◽

Rita Zlatkin ◽

Shiran Bookstein-Peretz ◽

Raanan Meyer ◽

Shali Mazaki-Tovi ◽

...

Keyword(s):

Cohort Study ◽

Preterm Birth ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Neonatal Morbidity ◽

Late Preterm ◽

Late Preterm Birth ◽

Antenatal Steroids ◽

Twin Pregnancies

Download Full-text

NEONATAL OUTCOMES FOLLOWING LATE PRETERM BIRTH

Fetal and Maternal Medicine Review ◽

10.1017/s0965539512000071 ◽

2012 ◽

Vol 23 (2) ◽

pp. 97-119 ◽

Cited By ~ 2

Author(s):

ELAINE M BOYLE

Keyword(s):

Preterm Birth ◽

Preterm Delivery ◽

Preterm Infants ◽

Neonatal Morbidity ◽

Neonatal Outcomes ◽

Late Preterm ◽

Very Preterm ◽

Late Preterm Birth ◽

Extremely Preterm ◽

Adverse Neonatal Outcomes

It is well recognised that birth before 32 weeks of gestation is associated with substantial neonatal morbidity and mortality and these risks have been extensively reported. The focus of perinatal research for many years has therefore been very preterm and extremely preterm delivery, since the likelihood and severity of adverse neonatal outcomes are highest within this group. In contrast, until recently, more mature preterm infants have been understudied and indeed, almost ignored by researchers.

Download Full-text

Morbidity in Late Preterm Birth: A Retrospective Cohort Study Assessing the Role of Immaturity versus Antecedent Factors

Neonatology ◽

10.1159/000515089 ◽

2021 ◽

pp. 1-8

Author(s):

Melissa Lorenzo ◽

Megan Laupacis ◽

Wilma M. Hopman ◽

Imtiaz Ahmad ◽

Faiza Khurshid

Keyword(s):

Cohort Study ◽

Preterm Birth ◽

Preterm Delivery ◽

Gestational Age ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Late Preterm ◽

Multiple Gestation ◽

Late Preterm Birth ◽

Apnea Of Prematurity

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.

Download Full-text

Metabolic-endocrine disruption due to preterm birth impacts growth, body composition, and neonatal outcome

Pediatric Research ◽

10.1038/s41390-021-01566-8 ◽

2021 ◽

Author(s):

Lea Sophie Möllers ◽

Efrah I. Yousuf ◽

Constanze Hamatschek ◽

Katherine M. Morrison ◽

Michael Hermanussen ◽

...

Keyword(s):

Body Composition ◽

Preterm Birth ◽

Postnatal Development ◽

Endocrine Disruption ◽

Fat Mass ◽

Neonatal Morbidity ◽

Neonatal Outcomes ◽

Endocrine Function ◽

List Type ◽

Term Infants

Abstract Despite optimized nutrition, preterm-born infants grow slowly and tend to over-accrete body fat. We hypothesize that the premature dissociation of the maternal–placental–fetal unit disrupts the maintenance of physiological endocrine function in the fetus, which has severe consequences for postnatal development. This review highlights the endocrine interactions of the maternal–placental–fetal unit and the early perinatal period in both preterm and term infants. We report on hormonal levels (including tissue, thyroid, adrenal, pancreatic, pituitary, and placental hormones) and nutritional supply and their impact on infant body composition. The data suggest that the premature dissociation of the maternal–placental–fetal unit leads to a clinical picture similar to panhypopituitarism. Further, we describe how the premature withdrawal of the maternal–placental unit, neonatal morbidities, and perinatal stress can cause differences in the levels of growth-promoting hormones, particularly insulin-like growth factors (IGF). In combination with the endocrine disruption that occurs following dissociation of the maternal–placental–fetal unit, the premature adaptation to the extrauterine environment leads to early and fast accretion of fat mass in an immature body. In addition, we report on interventional studies that have aimed to compensate for hormonal deficiencies in infants born preterm through IGF therapy, resulting in improved neonatal morbidity and growth. Impact Preterm birth prematurely dissociates the maternal–placental–fetal unit and disrupts the metabolic-endocrine maintenance of the immature fetus with serious consequences for growth, body composition, and neonatal outcomes. The preterm metabolic-endocrine disruption induces symptoms resembling anterior pituitary failure (panhypopituitarism) with low levels of IGF-1, excessive postnatal fat mass accretion, poor longitudinal growth, and failure to thrive. Appropriate gestational age-adapted nutrition alone seems insufficient for the achievement of optimal growth of preterm infants. Preliminary results from interventional studies show promising effects of early IGF-1 supplementation on postnatal development and neonatal outcomes.

Download Full-text