The clinical and diagnostic utility of S100B in preterm newborns.
Serpero Laura D,Pluchinotta Francesca,Gazzolo Diego
Clinica chimica acta; international journal of clinical chemistry
Preterm birth is still the most important cause of perinatal mortality and morbidity. Follow-up studies showed that the majority of neurological abnormalities during childhood are already present in the first week after birth. In this light, the knowledge of the timing of the insult and/or of the contributing factors is of utmost relevance in order to avoid adverse neurological outcome. Notwithstanding, the considerable advances in perinatal clinical care and monitoring, the early detection of cases at risk for brain damage is still a challenge because, when radiological pictures are still negative, brain damage may be already at a subclinical stage, with symptoms hidden by therapeutic strategies. Thus, it could be very relevant to measure quantitative parameters, such as neuroproteins, able to detect subclinical lesions at a stage when routine brain monitoring procedures are still silent. In the last decade, the assay of the brain-specific protein S100B in different biological fluids proved useful information on brain function and damage in the perinatal period. Therefore, the present study provides an overview of the most recent findings on S100B role as a reliable marker of brain development/damage in preterm high risk fetuses and newborns.
Expression of S100A Alarmins in Cord Blood Monocytes Is Highly Associated With Chorioamnionitis and Fetal Inflammation in Preterm Infants.
Golubinskaya Veronika,Puttonen Henri,Fyhr Ing-Marie,Rydbeck Halfdan,Hellström Ann,Jacobsson Bo,Nilsson Holger,Mallard Carina,Sävman Karin
Frontiers in immunology
Preterm infants exposed to chorioamnionitis and with a fetal inflammatory response are at risk for neonatal morbidity and adverse outcome. Alarmins S100A8, S100A9, and S100A12 are expressed by myeloid cells and have been associated with inflammatory activation and monocyte modulation. To study S100A alarmin expression in cord blood monocytes from term healthy and preterm infants and relate results to clinical findings, inflammatory biomarkers and alarmin protein levels, as well as pathways identified by differentially regulated monocyte genes. Cord blood CD14+ monocytes were isolated from healthy term ( = 10) and preterm infants (<30 weeks gestational age, = 33) by MACS technology. Monocyte RNA was sequenced and gene expression was analyzed by Principal Component Analysis and hierarchical clustering. Pathways were identified by Ingenuity Pathway Analysis. Inflammatory proteins were measured by Multiplex ELISA, and plasma S100A proteins by mass spectrometry. Histological chorioamnionitis (HCA) and fetal inflammatory response syndrome (FIRS) were diagnosed by placenta histological examination. S100A8, S100A9, and S100A12 gene expression was significantly increased and with a wider range in preterm vs. term infants. High S100A8 and S100A9 gene expression ( = 17) within the preterm group was strongly associated with spontaneous onset of delivery, HCA, FIRS and elevated inflammatory proteins in cord blood, while low expression ( = 16) was associated with impaired fetal growth and physician-initiated delivery. S100A8 and S100A9 protein levels were significantly lower in preterm vs. term infants, but within the preterm group high S100A gene expression, spontaneous onset of labor, HCA and FIRS were associated with elevated protein levels. One thousand nine hundred genes were differentially expressed in preterm infants with high vs. low S100A alarmin expression. Analysis of 124 genes differentially expressed in S100A high as well as FIRS and HCA groups identified 18 common pathways and S100A alarmins represented major hubs in network analyses. High expression of S100A alarmins in cord blood monocytes identifies a distinct clinical risk group of preterm infants exposed to chorioamnionitis and with a fetal inflammatory response. Gene and pathway analyses suggest that high S100A alarmin expression also affects monocyte function. The connection with monocyte phenotype and inflammation-stimulated S100A expression in other cell types (e.g., neutrophils) warrants further investigation.
S100B urine concentrations in late preterm infants are gestational age and gender dependent.
Sannia Andrea,Risso Francesco Maria,Zimmermann Luc J I,Gavilanes Antonio W D,Vles Hans J,Gazzolo Diego
Clinica chimica acta; international journal of clinical chemistry
BACKGROUND:Late preterm deliveries (LP, between 34 and 36wks), have considerably increased in the last decades. About 20-25% of LP infants who require intensive care and morbidity on public health are of great magnitude. Therefore, we aimed at offering a reference curve in LP period of a well-established neurotrophic and brain damage marker namely S100B protein. METHODS:We collected, between December 2009 and March 2012, urine samples, at first void (within 6-hours from birth) for S100B assessment, in 277 healthy LP infants consecutively admitted to our units. Standard clinical and laboratory monitoring parameters were also recorded. S100B was measured by using a commercially available immunoluminometric assay. RESULTS:S100B pattern in LP infants was characterized by a slight decrease in protein's concentration from 34 to 35wks. From 35wks onwards S100B started to increase reaching a significant difference (P=0.008) at 36wks. When corrected for gender, significantly higher (P<0.01, for all) S100B concentrations in female were observed from 34 to 36wks. Polynomial type-1 regression analysis showed a significant correlation (R=-0.05; P<0.001) between gestational age and S100B in LP infants considering either the whole study population or when corrected for gender. CONCLUSIONS:S100B in LP infants is gestational age and gender dependent. The present reference curve, for S100B in LP period, offers additional support to protein's neurotrophic role and suggests that gestational age and gender have to be taken into due account, whenever S100B is measured, in order to avoid bias factors.
Gestational diabetes: a strong independent risk factor for severe neonatal respiratory failure after 34 weeks.
Vignoles Pauline,Gire Catherine,Mancini Julien,Bretelle Florence,Boubli Léon,Janky Eustase,Carcopino Xavier
Archives of gynecology and obstetrics
PURPOSE:To evaluate if gestational diabetes (GD) exposes neonates delivered after 34 weeks to an increased risk of severe neonatal respiratory failure (NRF). METHODS:Data from 3,237 women who delivered after 34 weeks with systematic screening for GD were analyzed. Diagnosis of severe NRF required the association of clinical and radiological criteria with a minimum of 24 h of ventilation and admission to neonatal intensive care unit. RESULTS:A total of 166 (5.1%) cases of GD were identified. Severe NRF was diagnosed in 7 (4.21%) cases among women with GD as compared to 13 (0.42%) in others (p < 0.001). The rate of severe NRF was also significantly higher in cases of premature delivery (p < 0.001), fetal growth retardation (p < 0.001), and cesarean section (p = 0.005). After adjustment for these variables, GD was identified as an independent risk factor for NRF (AOR 11.55, 95% CI 3.9-33.9, p < 0.001). Two other risk factors were also identified: late preterm delivery (AOR 6.13, 95% CI 1.8-21.2, p = 0.004); and hypotrophy (AOR 9.16, 95% CI 2.7-30.5, p < 0.001). CONCLUSIONS:GD is an independent risk factor for severe NRF after 34 weeks. Neonates from such pregnancies should be monitored carefully.
Comparison of neonatal outcomes of small for gestational age and appropriate for gestational age preterm infants born at 28-36 weeks of gestation: a multicentre study in Ethiopia.
Gidi Netsanet Workneh,Goldenberg Robert L,Nigussie Assaye K,McClure Elizabeth,Mekasha Amha,Worku Bogale,Siebeck Matthias,Genzel-Boroviczeny Orsolya,Muhe Lulu M
BMJ paediatrics open
Purpose:The aim of this study was to assess morbidity and mortality pattern of small for gestational age (SGA) preterm infants in comparison to appropriate for gestational age (AGA) preterm infants of similar gestational age. Method:We compared neonatal outcomes of 1336, 1:1 matched, singleton SGA and AGA preterm infants based on their gestational age using data from the study 'Causes of Illness and Death of Preterm Infants in Ethiopia (SIP)'. Data were analysed using SPSS V.23. ORs and 95% CIs and χ tests were done, p value of <0.05 was considered statistically significant. Result:The majority of the infants (1194, 89%) were moderate to late preterm (32-36 weeks of gestation), 763 (57%) were females. Male preterm infants had higher risk of being SGA than female infants (p<0.001). SGA infants had increased risk of hypoglycaemic (OR and 95% CI 1.6 (1.2 to 2.0), necrotising enterocolitis (NEC) 2.3 (1.2 to 4.1), polycythaemia 3.0 (1.6 to 5.4), late-onset neonatal sepsis (LOS) 3.6 (1.1 to 10.9)) and prolonged hospitalisation 2.9 (2.0 to 4.2). The rates of respiratory distress syndrome (RDS), apnoea and mortality were similar in the SGA and AGA groups. Conclusion:Neonatal complications such as hypoglycaemic, NEC, LOS, polycythaemia and prolonged hospitalisation are more common in SGA infants, while rates of RDS and mortality are similar in SGA and AGA groups. Early recognition of SGA status, high index of suspicion and screening for complications associated and timely intervention to prevent complications need due consideration.
Systemic endogenous erythropoietin and associated disorders in extremely preterm newborns.
Holm Mari,Skranes Jon,Dammann Olaf,Fichorova Raina N,Allred Elizabeth N,Leviton Alan
Archives of disease in childhood. Fetal and neonatal edition
OBJECTIVE:To explore the association between concentrations of endogenous erythropoietin (EPO) in blood the first 2 weeks of life and neonatal disorders in extremely low gestational age newborns (ELGANs). DESIGN:Prospective cohort study. SETTING:Neonatal care units at 14 participating hospitals in the USA. PATIENTS:867 children born before the 28th week of gestation from the ELGAN study cohort. MAIN OUTCOME MEASURES:EPO blood concentrations were measured on postnatal days 1, 7 and 14. The following neonatal characteristics and disorders were registered: blood gases, early and late respiratory dysfunction, pulmonary deterioration, retinopathy of prematurity (ROP), necrotising enterocolitis (NEC) and bronchopulmonary dysplasia (BPD). We calculated the gestational age-adjusted ORs for having each disorder associated with an EPO blood concentration in the highest or lowest quartile, compared with infants whose EPO concentration was in the middle two quartiles on the corresponding day. RESULTS:Newborns whose day-1 EPO was in the highest quartile were at increased risk for early and persistent respiratory dysfunction during the first 2 weeks of life, and NEC requiring surgery. The lowest EPO quartile on day 1 was associated with a decreased risk of moderate BPD. The association between low EPO and decreased risk of respiratory complications persisted on day 7. On day 14, being in the highest EPO quartile was associated with increased risk of ROP, and BPD not requiring ventilation assistance. CONCLUSIONS:EPO blood concentrations in extremely preterm newborns during the first 2 weeks of life convey information about increased risks of bowel, lung and retinal diseases.
[Why perform routine brain sonography in late preterm infants?].
Kessel Irena,Gover Ayala,Waisman Dan,Soloveichick Marina,Nevo Keren Lavie,Rotschild Avi
We present a case of a late preterm baby with respiratory distress syndrome (RDS), prolonged jaundice and congenital hypothyroidism. The infant developed late lenticulostriate vasculopathy (LSV). LSV was previously described in association with various neurodevelopmental abnormalities and in this case would have been missed by the current US brain screening recommendations for newborns.
Perinatal morbidity associated with late preterm deliveries compared with deliveries between 37 and 40 weeks of gestation.
Cheng Y W,Kaimal A J,Bruckner T A,Halloran D R,Hallaron D R,Caughey A B
BJOG : an international journal of obstetrics and gynaecology
OBJECTIVE:To estimate the risk of short-term complications in neonates born between 34 and 36 weeks of gestation. DESIGN:This is a retrospective cohort study. SETTING:Deliveries in 2005 in the USA. POPULATION:Singleton live births between 34 and 40 weeks of gestation. METHODS:Gestational age was subgrouped into 34, 35, 36 and 37-40 completed weeks of gestation. Statistical comparisons were performed using chi-square test and multivariable logistic regression models, with 37-40 weeks of gestation designated as referent. MAIN OUTCOME MEASURES:Perinatal morbidities, including 5-minute Apgar scores, hyaline membrane disease, neonatal sepsis/antibiotics use, and admission to the intensive care unit. RESULTS:In all, 175,112 neonates were born between 34 and 36 weeks in 2005. Compared with neonates born between 37 and 40 weeks, neonates born at 34 weeks had higher odds of 5-minute Apgar <7 (adjusted odds ratio [aOR] 5.51, 95% CI 5.16-5.88), hyaline membrane disease (aOR 10.2, 95% CI 9.44-10.9), mechanical ventilation use >6 hours (aOR 9.78, 95% CI 8.99-10.6) and antibiotic use (aOR 9.00, 95% CI 8.43-9.60). Neonates born at 35 weeks were similarly at risk of morbidity, with higher odds of 5-minute Apgar <7 (aOR 3.42, 95% CI 3.23-3.63), surfactant use (aOR 3.74, 95% CI 3.21-4.22), ventilation use >6 hours (aOR 5.53, 95% CI 5.11-5.99) and neonatal intensive-care unit admission (aOR 11.3, 95% CI 11.0-11.7). Neonates born at 36 weeks remain at higher risk of morbidity compared with deliveries at 37-40 weeks of gestation. CONCLUSIONS:Although the risk of undesirable neonatal outcomes decreases with increasing gestational age, the risk of neonatal complications in late preterm births remains higher compared with infants delivered at 37-40 weeks of gestation.
Pulmonary vascular endothelial growth factor-C in development and lung injury in preterm infants.
Janér Joakim,Lassus Patrik,Haglund Caj,Paavonen Karri,Alitalo Kari,Andersson Sture
American journal of respiratory and critical care medicine
RATIONALE:In mice, vascular endothelial growth factor-C (VEGF-C) plays an important role in development of the lymphatic system and in pathogenesis of pulmonary inflammation. Its role in development of the lymphatic system in human lung and in lung injury in newborns remains unclear. OBJECTIVES:We studied the role of VEGF-C in developing human lung, and in acute and chronic lung injury in preterm infants. METHODS:Included in the immunohistochemistry study were 10 fetuses, 15 control neonates without primary lung disease, 15 preterm infants with respiratory distress syndrome, and 8 infants with bronchopulmonary dysplasia. Tracheal aspirate fluid samples of intubated very-low-birth-weight infants during Postnatal Weeks 1-5 were analyzed with ELISA. RESULTS:Bronchiolar staining for VEGF-C was observed in all 48 samples. Alveolar epithelial staining was seen in most fetuses (8/10). In addition, staining was observed in alveolar macrophages in bronchopulmonary dysplasia (4/8), and late respiratory distress syndrome (2/7). VEGF receptor-3 (VEGFR-3) staining was observed in lymphatic endothelium adjacent to vascular endothelium. VEGF-C was expressed consistently in tracheal aspirate fluid, being highest during the first 2 postnatal days. Antenatal administration of glucocorticoids was associated with higher VEGF-C in tracheal aspirate fluid. CONCLUSIONS:The pattern of pulmonary VEGF-C and VEGFR-3 protein expression and consistent VEGF-C protein appearance in tracheal aspirate fluid in human preterm infants indicate a role for VEGF-C in the physiologic development of the lymphatic system of the lung.
Neonatal outcome associated with singleton birth at 34-41 weeks of gestation.
Gouyon Jean-Bernard,Vintejoux Amélie,Sagot Paul,Burguet Antoine,Quantin Catherine,Ferdynus Cyril,
International journal of epidemiology
BACKGROUND:Approximately 75% of preterm births are late-preterm (34(0/7) to 36(6/7) weeks gestation). This group has usually been considered as a whole in studies assessing the outcome of these preterm infants by comparison with term infants. However, the respective contribution to prognosis of each week of gestation has not been fully clarified. METHODS:A population-based study of 150 426 live-born singleton neonates with gestational ages ranging from 34 to 41 weeks of gestation. RESULTS:The rate of severe respiratory disorders (treated by mechanical ventilation and/or nasal continuous positive airway pressure) markedly declined with gestational age from 19.8% at 34 weeks to 0.28% at 39-41 weeks. Between 34 and 38 weeks, each additional week diminished the relative risk (crude or adjusted) of severe respiratory disorders by a factor varying from 2 to 3. The rate of poor prognosis (death and/or severe neurological condition) significantly declined between 34 and 38 weeks and remained stable thereafter. A multivariate analysis showed that antepartum haemorrhage and hypertensive disorders during pregnancy were significantly associated with severe respiratory disorders and poor outcome. Diabetes was an additional factor associated with severe respiratory disorders. CONCLUSIONS:Future studies should delineate more precisely the respective contribution of gestational age, maternal complication and induced delivery in the prognosis of infants born between 33 and 39 weeks gestation.
[Late preterm infants--complications during the early period of adaptation].
Baumert Małgorzata,Agnieszka Lukomska,Krzych Lukasz J,Jacek Magnucki,Małgorzata Pacula
UNLABELLED:A subgroup of more mature preterm infants, so-called "near term" ("late preterm") infants, 34 weeks 0/7 days to 36 weeks 6/7 days, have become the interest of countless research recently OBJECTIVES:the aim of the study is the observation of more frequent occurrence of clinical problems in near-term infants in comparison with term infants. METHODS:A retrospective review, conducted from January 1, 2008 to December 31, 2008, included 1271 neonatal records and subset analyses of 312 near-term infants and 812 full term infants. RESULTS:Late preterm newborns were at higher risk of respiratory distress syndrome (p < 0.01), infections, (p = 0.00012) hyperbilirubinemia (p < 0.001), temperature instability (p < 0.001) and intraventricular hemorrhage (p < 0.001) than term infants. A prolonged infant stay at hospital (beyond 72 hours after vaginal delivery and 96 hours after a cesarean delivery) resulting from specific clinical problems was observed. CONCLUSIONS:Even a little shortened period of pregnancy influences the adaptation period of the infants and increases the occurrence of clinical problems like respiratory distress syndrome, hyperbilirubinemia, infections, temperature instability and intraventricular hemorrhage, when comparing to term infants.
Complications of the late preterm infant.
Darcy Ashley E
The Journal of perinatal & neonatal nursing
One of the goals of Healthy People 2010 (set in 1998) was to reduce preterm birthrates from 11.6% to 7.6%. However, in 2004, the preterm birthrate of 12.5% was actually higher than the rate in 1998. Approximately 65% of this increase in prematurity rate is attributed to the increasing birthrate of the late preterm infant. Care of the late preterm infant is far more complicated than many hospital policies and clinical guidelines imply. It cannot be stressed enough to frontline clinicians that late preterm infants are not full-term infants. Their care should not be defined by the same policies and practices that govern term infants. The purpose of this article is to explore the complications that accompany late preterm birth. The following complications will be discussed: thermoregulation challenges, feeding difficulty, late neonatal sepsis, prolonged physiologic jaundice, hypoglycemia, possible neurodevelopmental differences, and respiratory problems.
Neonatal morbidity and mortality of late-preterm babies.
Kalyoncu Ozlem,Aygün Canan,Cetinoğlu Erhan,Küçüködük Sükrü
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
OBJECTIVE:To analyze neonatal morbidity and mortality rates of late-preterms and to compare them with their term counterparts in a tertiary care unit in Turkey. STUDY DESIGN:The study included 252 late-preterm newborns (34 0/7--36 6/7 weeks' gestational age), admitted to Neonatal Intensive Care Unit in the first 24 h of life between January 2005 and June 2007 and 252 newborns born in the same hospital in the same period of time. Babies with major congenital and/or chromosomal abnormalities were excluded. RESULTS:The mortality rate was 2.3% in late-preterms. None of the term newborns died. Compared to terms, late-preterms were 11 times more likely to develop respiratory distress, 14 times more likely to have feeding problems, 11 times more likely to exhibit hypoglycemia, 3 times more likely to be readmitted and 2.5 times more likely to be rehospitalized. Late-prematurity, being large for gestational age, male gender, and cesarean delivery were significant risk factors for respiratory distress. CONCLUSION:Late-preterms have significantly higher risk of morbidity and mortality compared with term newborns. Greater concern and attention is required for the care of this ignored, at-risk population.
Relationship between thyroid hormone levels and transient tachypnea of the newborn in late-preterm, early-term, and term infants.
Kayıran Sinan Mahir,Erçin Seçil,Kayıran Petek,Gursoy Tugba,Gurakan Berkan
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
PURPOSE:We aimed to investigate the association between thyroid hormone levels and transient tachypnea of the newborn (TTN) among late-preterm, early-term, and term infants admitted to neonatal intensive care unit (NICU). MATERIALS AND METHOD:In the current retrospective study, neonates admitted to the NICU due to TTN were assigned to the TTN group (n = 404). Healthy neonates who were followed up in the well-baby nursery comprised the control group (n = 7335). Infants were grouped by gestational age into late-preterm (34-36 weeks), early-term (37-38 weeks), and term subgroups (39-41 weeks). Serum levels of thyroid-stimulating hormone (TSH) and thyroxin (T) were determined from venipuncture samples taken at least 48 hours after birth. The relationship between thyroid hormone levels and the need for NICU admission for TTN was compared between groups. RESULTS:Compared to control infants, term neonates with TTN had significantly higher TSH levels, whereas late-preterm and early-term neonates with TTN had significantly lower T levels. Birth weight and mode of delivery had no effect on NICU admission for TTN. CONCLUSIONS:Infants admitted to NICU due to TTN had significantly different thyroid hormone levels with differences depending on gestational age.
Epidemiology of respiratory distress and the illness severity in late preterm or term infants: a prospective multi-center study.
Ma Xiao-lu,Xu Xue-feng,Chen Chao,Yan Chao-ying,Liu Ya-ming,Liu Ling,Xiong Hong,Sun Hui-qing,Lai Jian-pu,Yi Bin,Shi Jing-yun,Du Li-zhong,
Chinese medical journal
BACKGROUND:The severity of respiratory distress was associated with neonatal prognosis. This study aimed to explore the clinical characteristics, therapeutic interventions and short-term outcomes of late preterm or term infants who required respiratory support, and compare the usage of different illness severity assessment tools. METHODS:Seven neonatal intensive care units in tertiary hospitals were recruited. From November 2008 to October 2009, neonates born at ≥ 34 weeks' gestational age, admitted at < 72 hours of age, requiring continuous positive airway pressure (CPAP) or mechanical ventilation for respiratory support were enrolled. Clinical data including demographic variables, underlying disease, complications, therapeutic interventions and short-term outcomes were collected. All infants were divided into three groups by Acute care of at-risk newborns (ACoRN) Respiratory Score < 5, 5 - 8, and > 8. RESULTS:During the study period, 503 newborn late preterm or term infants required respiratory support. The mean gestational age was (36.8 ± 2.2) weeks, mean birth weight was (2734.5 ± 603.5) g. The majority of the neonates were male (69.4%), late preterm (63.3%), delivered by cesarean section (74.8%), admitted in the first day of life (89.3%) and outborn (born at other hospitals, 76.9%). Of the cesarean section, 51.1% were performed electively. Infants in the severe group were more mature, had the highest rate of elective cesarean section, Apgar score < 7 at 5 minutes and resuscitated with intubation, the in-hospital mortality increased significantly. In total, 58.1% of the patients were supported with mechanical ventilation and 17.3% received high frequency oscillation. Adjunctive therapies were commonly needed. Higher rate of infants in severe group needed mechanical ventilation or high frequency oscillation, volume expansion, bicarbonate infusion or vasopressors therapy (P < 0.05). The incidence of complications was also increased significantly in severe group (P < 0.05). The in-hospital mortality in the severe group was significantly higher than other two groups (P < 0.05). ACoRN Respiratory Score was correlated with Score for Neonatal Acute Physiology-Version II (SNAP-II) (P < 0.01). High gestational age, high SNAP-II score and oxygenation index (OI), and Apgar score at 5 minutes < 5 were independent risks for death. CONCLUSIONS:Neonatal respiratory distress is still a common cause of hospitalization in China. Illness severity assessment is important for the management. ACoRN Respiratory Score which correlated with SNAP-II score is easy to use and may be helpful in facilitating the caregivers in local hospital to identify the early signs and make the transfer decision promptly.
[A multicenter study on the surfactant treatment in late-preterm or term infants with respiratory distress syndrome].
Zhonghua er ke za zhi = Chinese journal of pediatrics
OBJECTIVE:To investigate the efficacy and safety of surfactant when it was used to treat late-preterm or term infants with respiratory distress syndrome (RDS). METHOD:Infants who were born at ≥34 weeks' gestational age and diagnosed with respiratory distress syndrome, required mechanical ventilation, admitted to 8 tertiary NICUs at <72 hours of age were enrolled. Surfactant was given if the infant required FiO2≥0.4 to maintain PaO2≥50 mmHg(1 mmHg=0.133 kPa) or SpO2>90%. Before and after surfactant treatment, the results of blood gas, ventilator settings, and the incidence of complications were recorded and analyzed. Comparison between continuous variables was made by t-test or one way analysis of variance (ANOVA). Categorical data was analyzed by a 2-tailed Pearson χ2 test. RESULT:Totally 96 infants were enrolled in this prospective study. The mean gestational age was (36.5±2.1) weeks. Of whom, 71.9% (n=69) were male, 59.4% (n=57) were late-preterm infants, 62.5% (n=60) were delivered by elective cesarean section. The first dose of surfactant was given at the median age of 13.3 hours with the dosage of (109±20) mg/kg. The second dose was given to 10.4% (n=10) infants. Half an hour post surfactant, PaO2/FiO2, OI, A-aDO2, PaO2/PAO2 improved significantly, and lasted for 6 hours. The mean length of hospital stay was (19±9) days, median medical cost was (39,000±36,000) yuan. Totally 73 cases (76.0%) were discharged after the treatment completed. Compared to small dosage, the improvement of PaO2/FiO2, OI, A-aDO2, PaO2/PAO2 was more significant at 6 hours after relatively large dose (≥100 mg/kg) of surfactant, and the length of mechanical ventilation was shorter. But the length of hospital stay, medical costs, and the incidence of complications was not significantly different between these two dosage groups. CONCLUSION:Surfactant significantly improved the oxygenation in late-preterm or term infants with respiratory distress syndrome.
Inositol in preterm infants at risk for or having respiratory distress syndrome.
Howlett Alexandra,Ohlsson Arne,Plakkal Nishad
The Cochrane database of systematic reviews
BACKGROUND:Inositol is an essential nutrient required by human cells in culture for growth and survival. Inositol promotes maturation of several components of surfactant and may play a critical role in fetal and early neonatal life. A drop in inositol levels in infants with respiratory distress syndrome (RDS) can be a sign that their illness will be severe. OBJECTIVES:To assess the effectiveness and safety of supplementary inositol in preterm infants with or without respiratory distress syndrome (RDS) in reducing adverse neonatal outcomes including: death (neonatal and infant deaths), bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), intraventricular haemorrhage (IVH), periventricular leukomalacia (PVL), necrotizing enterocolitis (NEC) and sepsis. SEARCH METHODS:We used the standard search strategy of Cochrane Neonatal to search the Cochrane Central Register of Controlled Trials (CENTRAL 2018, Issue 11), MEDLINE via PubMed (1966 to 5 November 2018), Embase (1980 to 5 November 2018), and CINAHL (1982 to 5 November 2018). We searched clinical trial databases, conference proceedings, and the reference lists of retrieved articles for randomised controlled trials (RCT) and quasi-randomised trials. SELECTION CRITERIA:We included all randomised controlled trials of inositol supplementation of preterm infants compared with a control group that received a placebo or no intervention. Outcomes included neonatal death, infant death, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), intraventricular haemorrhage (IVH), necrotizing enterocolitis (NEC) and sepsis. DATA COLLECTION AND ANALYSIS:The three review authors independently abstracted data on neonatal outcomes and resolved any disagreements through discussion and consensus. Outcomes were reported as typical risk ratio (RR), risk difference (RD) and number needed to treat for an additional beneficial outcome (NNTB) or number needed to treat for an additional harmful outcome (NNTH). We used the GRADE approach to assess the quality of evidence. MAIN RESULTS:Six published randomised controlled trials were identified, with a total of 1177 infants. Study quality varied for the comparison 'Inositol supplementation to preterm infants (repeat doses in any amount and any duration of treatment) versus control' and interim analyses had occurred in several trials for the outcomes of interest. In this comparison, neonatal death was found to be significantly reduced (typical RR 0.53, 95% CI 0.31 to 0.91; typical RD -0.09, 95% CI -0.16 to -0.01; NNTB 11, 95% CI 6 to 100; 3 trials, 355 neonates). Infant deaths were not reduced (typical RR 0.89, 95% CI 0.71 to 1.13; typical RD -0.02, 95% CI -0.07 to 0.02; 5 trials, 1115 infants) (low-quality evidence). ROP stage 2 or higher or stage 3 or higher was not significantly reduced (typical RR 0.89, 95% CI 0.75 to 1.06; typical RD -0.04, 95% CI -0.10 to 0.02; 3 trials, 810 infants) (moderate-quality evidence). There were no significant findings for ROP (any stage), NEC (suspected or proven), sepsis, IVH grade greater than II (moderate-quality evidence). For the comparison 'Inositol supplementation IV initially followed by enteral administration (repeat doses of 80 mg/kg/day) in preterm infants born at less than 30 weeks' postmenstrual age (PMA) compared to placebo for preterm infants at risk for or having respiratory distress syndrome' the results from two studies of high quality were included (N = 760 neonates). Recruitment to the larger study (N = 638) was terminated because of a higher rate of deaths in the inositol group. We did not downgrade the quality of the study. The meta-analyses of the outcomes of 'Type 1 ROP or death before determination of ROP outcome using the adjudicated ROP outcome', 'Type 1 ROP including adjudicated ROP outcome', 'All-cause mortality (outcome collected through first event: death, hospital discharge, hospital transfer, or 120 days after birth)' and 'Severe IVH (grade 3 or 4)' did not show significant findings (moderate-quality evidence). There were no significant findings for the outcomes 'BPD or death by it prior to 37 weeks' postmenstrual age (outcomes collected through first event: death, hospital discharge, hospital transfer, or 120 days after birth)', 'Late onset sepsis (> 72 hours of age)', and 'Suspected or proven NEC' (high-quality evidence). AUTHORS' CONCLUSIONS:Based on the evidence from randomised controlled trials to date, inositol supplementation does not result in important reductions in the rates of infant deaths, ROP stage 3 or higher, type 1 ROP, IVH grades 3 or 4, BPD, NEC, or sepsis. These conclusions are based mainly on two recent randomised controlled trials in neonates less than 30 weeks' postmenstrual age (N = 760), the most vulnerable population. Currently inositol supplementation should not be routinely instituted as part of the nutritional management of preterm infants with or without RDS. It is important that infants who have been enrolled in the trials included in this review are followed to assess any effects of inositol supplementation on long-term outcomes in childhood. We do not recommend any additional trials in neonates.
[Clinical characteristics and outcomes of respiratory distress syndrome in term and late-preterm neonates].
Chen An,Shi Li-ping,Zheng Ji-yan,Du Li-zhong
Zhonghua er ke za zhi = Chinese journal of pediatrics
OBJECTIVE:Respiratory distress syndrome (RDS) is a frequently seen acute respiratory disorder in the newborn infants. Since the original description of deficiency of the pulmonary surfactant in premature neonates by Avery in 1959, RDS has most commonly been attributed to developmental immaturity of surfactant production. But in clinical practice it has been found that there was RDS in term and late-term neonates. Many of them were recognized as transient tachypnea at the beginning, they were diagnosed as RDS until respiratory distress and the typical radiological signs were demonstrated. The purpose of this study was to investigate the clinical characteristics of RDS of term and late-term neonates. METHODS:All neonates admitted to the neonatal intensive care unit of the Children's Hospital, Zhejiang University School of Medicine between May, 2005 and May, 2007 on the basis of RDS were analyzed. RDS was diagnosed when respiratory distress and the typical radiological signs were documented. Patients were grouped into preterm group (Group 1, gestational age < 35 w, n = 103) and term and late-term group (Group 2, gestational age > or = 35 w, n = 74). RESULTS:In Group 1, 76 preterm infants were male, the mean gestational age was 31.1 w, the mean Apgar score at 1 min was 7.6, the mean birth weight was 1702 g, 56 cases were vaginally delivered and 47 were delivered through Cesarean section. Only one was delivered via elective Cesarean section before onset of labor. A total of 88 patients needed mechanical ventilation (MV), the time for beginning MV was 8.7 h (1 - 72 h), and lasted for 4.3 d (0.5 - 29 d). The oxygenation index (OI) was 11.9 (10.00 - 52.63) and PaO2/PAO2 was 0.29 (0.03 - 0.98). Four patients had an OI > 40. A total of 28 patients were treated with pulmonary surfactant (PS), and 11 of the 28 underwent MV, the OI before and 2 h, 8 - 12 h and 20 - 24 h after using PS were 10.5, 5.4, 3.4, and 4.3, respectively (P < 0.01). A total of 33 patients in Group 1 had intracranial hemorrhage, 4 patients had pneumothorax, 4 patients had persistent pulmonary hypertension of the newborn (PPHN) and 15 patients had ventilator associated pneumonia (VAP). In Group 2, 54 infants were male, the mean gestational age was 37 w, the mean Apgar score at 1 min was 8.5, the mean birth weight was 2789 g, 8 cases were vaginally delivered, 66 were delivered through Cesarean section and 59 were delivered via elective Cesarean section before onset of labor. A total of 63 patients needed MV, the time for beginning MV was 27.8 h (1 - 72 h, compared to Group 1, P < 0.01), and lasted for 3.7 d (0.5 - 13.5 d). The OI was 19.70 (10.00 - 56.67, compared to Group 1, P < 0.01) and PaO2/PAO2 was 0.16 (0.017 - 0.470, compared to Group 1, P < 0.01). Seven patients had an OI > 40. A total of 8 patients were treated with PS and 7 of them had MV, the OI before and 2 h, 8 - 12 h and 20 - 24 h after using PS were 11.2, 7.6, 7.5, and 7.6 (the last two compared to group 1, P < 0.01, respectively). A total of 16 patients had pneumothorax, 10 patients had intracranial hemorrhage, 16 patients had PPHN and 7 patients had VAP. CONCLUSION:Most of the term and late-term neonates who developed RDS were delivered through cesarean section before onset of labor. They underwent MV later. The oxygenation was worse than RDS in preterm infants. PS did not have the same effect as seen in preterm infants. They had more pneumothorax and PPHN.
Effects of surfactant treatment in late preterm infants with respiratory distress syndrome.
Dani Carlo,Mosca Fabio,Vento Giovanni,Tagliabue Paolo,Picone Simonetta,Lista Gianluca,Fanos Vassilios,Pratesi Simone,Boni Luca
The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians
OBJECTIVE:To evaluate surfactant effectiveness for the treatment of respiratory distress syndrome (RDS) in late preterm infants. METHODS:We performed a retrospective cohort study of infants born between 34 and 36 weeks of gestation admitted for respiratory failure in seven perinatal centers from January 2010 to December 2014. We evaluated changes of FiO, PaO and a/APO in surfactant-treated patients, and the need and duration of MV, the duration of noninvasive respiratory support, stay in NICU and in hospital in surfactant-treated and untreated late preterm infants with RDS alone. RESULTS:We studied 562 infants with RDS, 252 (45%) were treated with surfactant and 310 (55%) were not. FiO, PaO and a/APO significantly improved after surfactant treatment. The adjusted odds ratio for the need of MV and the adjusted differences of duration of noninvasive respiratory support, and of NICU and hospital stay were not different in the surfactant and non-surfactant groups. CONCLUSIONS:Surfactant therapy was followed by a quick and persisting significant improvement of respiratory function in late preterm infants with RDS. Surfactant did not improve short-term outcomes in our population probably because other factors such as the gestational age, occurrence of complications and poor feeding play a relevant role.
Respiratory distress syndrome at birth is a risk factor for hospitalization for lower respiratory tract infections in infancy.
Szabo Shelagh M,Gooch Katherine L,Korol Ellen E,Bradt Pamela,Vo Pamela,Levy Adrian R
The Pediatric infectious disease journal
BACKGROUND:Respiratory distress syndrome (RDS) and hospitalization for lower respiratory tract infection (LRTI; specifically, respiratory syncytial virus) are important causes of morbidity in infancy. Whether RDS at birth is an independent risk factor for LRTI is unknown. This study estimated the risk of LRTI-related hospitalization among late preterm infants with a history of RDS. METHODS:The population-based cohort from Québec included all late preterm infants (32-36 weeks gestational age) born in 1996 to 1997. RDS was identified by International Classification of Diseases, Ninth Revision code 769, and a comparison cohort generated from all without RDS. A multivariable model estimated the adjusted odds ratio of LRTI-related hospitalization among late preterm infants with a history of RDS; and the incidence and increased risk of childhood chronic respiratory morbidity was calculated. RESULTS:Of the 7488 late preterms, 459 (6.1%) had a history of RDS; 525 late preterms (7.0%) were hospitalized for LRTI in infancy, including 57 (12.4%) with RDS. The adjusted odds ratio for LRTI-related hospitalization associated with RDS was 1.6 (1.2-2.2). Other significant risk factors included male sex, or diagnosis of other respiratory conditions, diaphragm anomalies, bacteremia, intraventricular hemorrhage, congenital heart disease or respiratory system anomalies. Late preterm infants with a history of RDS were also at a significantly increased risk of childhood chronic respiratory morbidity. CONCLUSIONS:Late preterms with a history of RDS are at a 60% increased risk of LRTI-related hospitalization in infancy compared with late preterm infants without RDS. Such infants may benefit from interventions decreasing the risk of contracting respiratory viruses causing acute LRTI.
Perinatal outcomes from preterm and early term births in a multicenter cohort of low risk nulliparous women.
Souza Renato T,Costa Maria L,Mayrink Jussara,Feitosa Francisco E,Rocha Filho Edilberto A,Leite Débora F,Vettorazzi Janete,Calderon Iracema M,Sousa Maria H,Passini Renato,Baker Philip N,Kenny Louise,Cecatti Jose G,
Preterm birth is the major contributor for neonatal and under-five years mortality rates and also accounts for a short- and long-term adverse consequences up to adulthood. Perinatal outcomes may vary according to lots of factors as preterm subtype, late prematurity, which account for the vast majority of cases, country and population characteristics. An under-recognition of the perinatal outcomes and its associated factors might have underpowered strategies to provide adequate care and prevent its occurrence. We aim to estimate the frequency of maternal and perinatal outcomes in women with different categories of preterm and term births, factors associated with poorer perinatal outcomes and related management interventions. A multicentre prospective cohort in five maternities in Brazil between 2015 and 2018. Nulliparous low-risk women with singletons were included. Comprehensive data were collected during three antenatal visits (at 19-21weeks, 27-29 weeks and 37-39 weeks). Maternal and perinatal outcomes were also collected according to maternal and neonatal medical records. Women who had spontaneous (sPTB) and provider-initiated (pi-PTB) preterm birth were compared to those who had term birth. Also, late preterm birth (after 34 weeks), and early term (37-38 weeks) were compared to full term birth (39-40 weeks). Bivariate analysis estimated risk ratios for maternal and adverse outcomes. Finally, a multivariate analysis was conducted to address factors independently associated with any adverse perinatal outcome (APO). In total, 1,165 women had outcome data available, from which 6.7% had sPTB, 4.0% had pi-PTB and 89.3% had a term birth. sPTB and pi-PTb were associated with poorer perinatal outcomes, as well as late sPTB, late pi-PTB and early term neonates. pi-PTB (RR 8.12, 95% CI [2.54-25.93], p-value 0.007), maternal weight gain between 20 and 27 weeks <p10 (RR 2.04, 95% CI [1.23-3.38], p-value 0.018) and participants from the Northeast centres (RR 2.35, 95% CI [1.11-4.95], p-value 0.034) were independently associated with APO. According to our findings, Brazil would benefit from strategies to more accurately identify women at higher risk for PTB, to promote evidenced-based decision in preterm and early term provider-initiated deliveries, and to prevent perinatal adverse outcomes.
Postnatal length and weight growth velocities according to Fenton reference and their associated perinatal factors in healthy late preterm infants during birth to term-corrected age: an observational study.
Zhang Li,Li Yan,Liang Shuang,Liu Xiao-Juan,Kang Feng-Ling,Li Gui-Mei
Italian journal of pediatrics
BACKGROUND:Optimum early postnatal growth is critical for early and later health of preterm infants. Postnatal length and weight growth velocities and their associated perinatal factors in healthy late preterm infants without restriction of neonatal complications and nutritional problems have not been widely studied. METHODS:As part of ongoing longitudinal follow-up study of growth and development of preterm infants in Shandong Qianfoshan Hospital in China, 599 healthy late preterm infants without neonatal complications and nutritional problems were sampled from 795 preterm infants born in January 2014 to April 2017. Perinatal factors, growth parameters, growth velocities(ΔLengthZ and ΔWeightZ: Z-score changes of length and weight) during birth and term-corrected age were documented. Associated variables of growth velocities were analyzed by bivariate and multivariate regression analyses. Adjusted ΔLengthZ and ΔWeightZ were compared between/among subgroups of associated variables using analysis of covariance. Catch-up growth were defined as ΔLengthZ or ΔWeightZ > 0.67. RESULTS:The mean ΔLengthZ and ΔWeightZ were 0.28, 0.65, respectively. Catch-up growth of length and weight was ubiquitous(30.7, 46.2%, respectively). Faster length growth velocity was associated with male, larger postmenstrual age(PMA) at birth, younger mother and larger PMA at visit; Faster weight growth velocity was associated with male, unfavorable intrauterine growth status defined by birth weight percentile(Small-for-Gestational-Age(<P10), Appropriate-for-Gestational-Age(P10-90), Large-for-Gestational-Age(>P90)), twin and larger PMA at visit. When adjusted for associated co-variables, weight catch-up growth existed in subgroups of 36 weeks PMA at birth, male, twin and SGA, while AGA almost reached this standard with mean adjusted ΔWeightZ as 0.66. Although none of these subgroups got length catch-up growth standard, infants of 36 weeks PMA at birth had statistically rapider length growth velocity than 34 and 35 weeks PMA at birth subgroups(mean adjusted ΔLengthZs of 34, 35 and 36 weeks subgroups: 0.10, 0.22, 0.38, respectively). CONCLUSIONS:Postnatal length and weight growth velocities of healthy late preterm infants from birth to term-corrected age were much superior than that of Fenton reference, especially for weight, with ubiquitous catch-up growth. Different associated factors for length and weight growth signified the necessity of constructing more detailed growth standards by specific stratification for associated factors.
Late preterm infants - impact of perinatal factors on neonatal results. A clinical study.
Jakiel Grzegorz,Wilińska Maria,Bińkowska Małgorzata,Kowal Anna,Rumowska Sylwia,Ciebiera Michał
Annals of agricultural and environmental medicine : AAEM
INTRODUCTION:Infants born between the 34(th) - 36(th) week of pregnancy account for 75% of all preterm infants. Their seemingly slight immaturity is related to serious health problems. OBJECTIVE:The aim of the study was to analyse perinatal factors that influence the occurrence in infants of such problems as respiratory failure, metabolic problems and early onset sepsis (EOS). MATERIALS AND METHOD:The material for the study included all mothers and their late preterm infants: 34+0 - 36+6 born in our hospital (a tertiary referral academic centre) in 2010 and 2011. The course of pregnancy and delivery, the type of delivery, applied preventive measures and treatment, as well as demographic data and the clinical state of infants were all analysed. Data from individual documentation of each mother and infant were collected by 5 designated people and data reliability was independently monitored by a random control of the documentation conducted by the supervising person. RESULTS:A statistically significant relationship between the occurrence of respiratory distress syndrome and infant immaturity, bad state after birth and sepsis in infants were confirmed. Sepsis was more common in the case of vaginal delivery, and coexisted with respiratory distress syndrome. The mother's diseases during pregnancy, a perinatal preventive antibiotic therapy, and possible delivery complications did not influence the infection. Perinatal asphyxia in an infant positively correlated with a Caesarean section and respiratory distress syndrome after birth. CONCLUSIONS:It is necessary to thoroughly establish the type of delivery of a late preterm infant in order to prevent an infection in the newborn child. The improvement of diagnosis of intrauterine hypoxia may reduce the number of Caesarean sections. The decision about late preterm delivery should be based on indices of the mother's state of health. Premature delivery is related to the occurrence of respiratory distress syndrome in a late preterm infant, although the risk is reduced by the application of an antenatal steroid therapy.
Avoiding late preterm deliveries to reduce neonatal complications: an 11-year cohort study.
Bouchet Noémie,Gayet-Ageron Angèle,Lumbreras Areta Marina,Pfister Riccardo Erennio,Martinez de Tejada Begoña
BMC pregnancy and childbirth
BACKGROUND:Late preterm (LPT) newborns, defined as those born between 34 0/7 and 36 6/7 gestational weeks, have higher short- and long-term morbidity and mortality than term infants (≥37 weeks). A categorization to justify a non-spontaneous LPT delivery has been proposed to distinguish evidence-based from non-evidence-based criteria. This study aims to describe rates and temporal trends of non-spontaneous LPT neonates delivered according to evidence-based or non-evidence-based criteria and to evaluate the number of avoidable LPT deliveries, including severe neonatal morbidity rates and associated risk factors. METHODS:Retrospective cohort study including all LPT neonates born at a Swiss university maternity unit between January 1, 2002 and December 31, 2012. Trends of LPT neonates and neonatal complications were assessed across time using Poisson regression and risk factors for neonatal complications by logistic regression. RESULTS:Among 40,609 singleton live births, 4223 (10.5%) were preterm and 2017 (4.9%) LPT. In the latter group, 26.2% were non-spontaneous (evidence-based: 12.0%; non-evidence-based: 14.2%). The most frequent indications for evidence-based non-spontaneous LPT delivery were severe preeclampsia (51.8%) and abnormal fetal tracing (24.7%). Indications for non-evidence-based non-spontaneous LPT deliveries were hemorrhage (36.2%) and mild preeclampsia (15.7%). LPT birth rates remained stable over time. The rate of neonatal complications after non-evidence-based LPT birth remained high over time (43.8% vs. 43.5% in 2002 and 2012, respectively; P = 0.645), whereas the annual proportion of neonatal complications overall showed a decreasing trend (from 38.0% in 2002 to 33.5% in 2012; P = 0.051). CONCLUSIONS:LPT birth rates were stable over time, but neonatal complications remained high, particularly after non-evidence-indicated LPT birth. A total of 287 LPT births could have been potentially avoided if an evidence-based protocol for delivery indications had been used. Efforts should be made to avoid non-spontaneous LPT births in order to reduce neonatal complications.
The risk of neonatal respiratory morbidity according to the etiology of late preterm delivery.
Kim Sung Ae,Lee Seung Mi,Kim Byoung Jae,Park Chan-Wook,Park Joong Shin,Jun Jong Kwan,Yoon Bo Hyun
Journal of perinatal medicine
OBJECTIVE:The risk of neonatal respiratory morbidity between indicated deliveries vs. spontaneous deliveries has not been consistent in previous studies, in spite of the traditional belief that chronic intrauterine stress might have protective effect on fetal lung maturation. We hypothesized that the heterogeneous etiology of indicated preterm delivery may obscure the relationship between the etiologies of preterm birth and neonatal respiratory morbidity. To address this issue, we divided the indicated preterm birth (PTB) into medically-indicated (without fetal compromise) PTB and maternal/fetal-indicated PTB, and compared the neonatal respiratory morbidity according to the etiology of late PTB. STUDY DESIGN:Neonatal respiratory morbidities were examined in neonates who were delivered between 34+0 and 36+6 weeks of gestation according to the etiology of PTB: 1) medically-indicated PTB (but without fetal compromise), 2) maternal/fetal-indicated PTB, or 3) spontaneous PTB such as preterm labor or preterm premature rupture of membranes. RESULTS:A total of 710 late preterm neonates were included in the study population, including 31 cases of medically-indicated PTB, 202 cases of maternal/fetal-indicated PTB, and 477 cases of spontaneous PTB. The rate of composite respiratory morbidity in cases of medically-indicated PTB is higher than both maternal/fetal-indicated PTB and spontaneous PTB (19% in medically-indicated PTB, 6% in maternal/fetal-indicated PTB, and 7% in spontaneous PTB). This difference between medically-indicated PTB and maternal/fetal-indicated PTB remained significant after adjustment for confounding variables. CONCLUSION:The medically-indicated PTB is associated with highest risk of neonatal respiratory morbidity in late PTB.
Past and Present: A Review of Antenatal Corticosteroids and Recommendations for Late Preterm Birth Steroids.
Dixon C Luke,Too Gloria,Saade George R,Gyamfi-Bannerman Cynthia
American journal of perinatology
Since 1972, the beneficial neonatal effects of antenatal corticosteroids (ACSs) have been repeatedly demonstrated in pregnancies at risk of preterm birth before 34 weeks' gestation. While ACS utilization before 34 weeks has been high since the 1990s, knowledge gaps regarding the risks and benefits of ACS continue to exist. Recent evidence has been published regarding the benefit of ACS in the late preterm period. This review addresses the evidence and knowledge gaps for ACS use before and after 34 weeks' gestation. We also provide recommendations for ACS use in the late preterm period.
Maternal, fetal, and placental conditions associated with medically indicated late preterm and early term delivery: a retrospective study.
Brown H K,Speechley K N,Macnab J,Natale R,Campbell M K
BJOG : an international journal of obstetrics and gynaecology
OBJECTIVE:Our objectives were: (1) to examine the association between maternal, fetal, and placental phenotypes of preterm delivery and medically indicated early delivery of singletons during the late preterm and early term periods; and (2) to identify the specific maternal, fetal, and placental conditions associated with these early deliveries. DESIGN:Retrospective study. SETTING:City of London and Middlesex County, Ontario, Canada. SAMPLE:Singleton live deliveries, at 34-41 weeks of gestation to women in London and Middlesex. METHODS:We obtained data from a city-wide perinatal database (2002-2011; n = 25 699). We used multinomial logistic regression for multivariable analyses. MAIN OUTCOME MEASURE:The outcome was the occurrence of medically indicated late preterm (34-36 weeks of gestation) and early term (37-38 weeks of gestation) delivery, versus delivery at full term (39-41 weeks of gestation). RESULTS:After controlling for confounding factors, all phenotypes were associated with increased odds of medically indicated late preterm and early term delivery. Within the maternal phenotype, chronic maternal medical conditions were associated with increased odds of medically indicated early term delivery (e.g. for gastrointestinal disease, adjusted odds ratio, aOR 1.72, 95% CI 1.47-2.00; for anaemia, aOR 1.40, 95% CI 1.20-1.63), but not late preterm delivery. CONCLUSIONS:The aetiology of medically indicated early delivery close to full term is heterogeneous. Patterns of associations suggest slightly different conditions underlying the late preterm and early term phenotypes, with chronic maternal medical conditions being associated with early term delivery but not with late preterm delivery. These results have implications for the prevention of early delivery as well as the identification of high-risk groups among those born early. TWEETABLE ABSTRACT:The aetiology of medically indicated late preterm and early term delivery is heterogeneous.
Epidemiology of late and moderate preterm birth.
Shapiro-Mendoza Carrie K,Lackritz Eve M
Seminars in fetal & neonatal medicine
Preterm birth affects 12.5% of all births in the USA. Infants of Black mothers are disproportionately affected, with 1.5 times the risk of preterm birth and 3.4 times the risk of preterm-related mortality. The preterm birth rate has increased by 33% in the last 25 years, almost entirely due to the rise in late preterm births (34-36 weeks' gestation). Recently attention has been given to uncovering the often subtle morbidity and mortality risks associated with moderate (32-33 weeks' gestation) and late preterm delivery, including respiratory, infectious, and neurocognitive complications and infant mortality. This section summarizes the epidemiology of moderate and late preterm birth, case definitions, risk factors, recent trends, and the emerging body of knowledge of morbidity and mortality associated with moderate and late preterm birth.
Risk factors associated with late preterm births in the underdeveloped region of China: A cohort study and systematic review.
Lu Liqun,Qu Yi,Tang Jun,Chen Dapeng,Mu Dezhi
Taiwanese journal of obstetrics & gynecology
OBJECTIVE:To determine factors associated with late preterm births in an underdeveloped region of China, and search for relevant reports in other underdeveloped regions by a systematic review. MATERIALS AND METHODS:Data of births occurring between January 2004 and December 2008 from eight hospitals in Western Sichuan Province, China, were analyzed. Late preterm birth was defined as delivery at 34-36 6/7 weeks' gestation. Medline, Cochrane Library, and Google Scholar were searched for studies which reported the risk factors of late preterm births in undeveloped regions until January 31, 2014. RESULTS:During the study period there were 4711 late preterm births and 54,574 term births. The odds ratios (ORs) for a late preterm birth of mothers < 20 years and ≥ 35 years of age were 3.813 [95% confidence interval (CI): 3.256-4.465] and 1.872 (95% CI: 1.677-2.090), respectively, as compared with an age of 20-34.9 years. Mothers who received prenatal care were less likely (OR = 0.623, 95% CI: 0.582-0.667) and those with a multiple gestation were more likely (OR = 9.346, 95% CI: 7.813, 11.236) to have a late preterm birth. The systematic review found that the incidence of late preterm births ranged from 4.4% to 16%, and the most prominent risk factors were eclampsia, preeclampsia, placenta previa, placental abruption, and twin pregnancy. CONCLUSION:A number of factors are associated with late preterm births, and the incidence in underdeveloped regions is high. The inconsistent results between our study and previous reports indicate more attention towards preventing late preterm births in undeveloped regions is needed.
Antenatal corticosteroids for accelerating fetal lung maturation for women at risk of preterm birth.
McGoldrick Emma,Stewart Fiona,Parker Roses,Dalziel Stuart R
The Cochrane database of systematic reviews
BACKGROUND:Respiratory morbidity including respiratory distress syndrome (RDS) is a serious complication of preterm birth and the primary cause of early neonatal mortality and disability. Despite early evidence indicating a beneficial effect of antenatal corticosteroids on fetal lung maturation and widespread recommendations to use this treatment in women at risk of preterm delivery, some uncertainty remains about their effectiveness particularly with regard to their use in lower-resource settings, different gestational ages and high-risk obstetric groups such as women with hypertension or multiple pregnancies. This updated review (which supersedes an earlier review Crowley 1996) was first published in 2006 and subsequently updated in 2017. OBJECTIVES:To assess the effects of administering a course of corticosteroids to women prior to anticipated preterm birth (before 37 weeks of pregnancy) on fetal and neonatal morbidity and mortality, maternal mortality and morbidity, and on the child in later life. SEARCH METHODS:We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (3 September 2020), ClinicalTrials.gov, the databases that contribute to the WHO International Clinical Trials Registry Platform (ICTRP) (3 September 2020), and reference lists of the retrieved studies. SELECTION CRITERIA:We considered all randomised controlled comparisons of antenatal corticosteroid administration with placebo, or with no treatment, given to women with a singleton or multiple pregnancy, prior to anticipated preterm delivery (elective, or following rupture of membranes or spontaneous labour), regardless of other co-morbidity, for inclusion in this review. DATA COLLECTION AND ANALYSIS:We used standard Cochrane Pregnancy and Childbirth methods for data collection and analysis. Two review authors independently assessed trials for inclusion, assessed risk of bias, evaluated trustworthiness based on predefined criteria developed by Cochrane Pregnancy and Childbirth, extracted data and checked them for accuracy, and assessed the certainty of the evidence using the GRADE approach. Primary outcomes included perinatal death, neonatal death, RDS, intraventricular haemorrhage (IVH), birthweight, developmental delay in childhood and maternal death. MAIN RESULTS:We included 27 studies (11,272 randomised women and 11,925 neonates) from 20 countries. Ten trials (4422 randomised women) took place in lower- or middle-resource settings. We removed six trials from the analysis that were included in the previous version of the review; this review only includes trials that meet our pre-defined trustworthiness criteria. In 19 trials the women received a single course of steroids. In the remaining eight trials repeated courses may have been prescribed. Fifteen trials were judged to be at low risk of bias, two had a high risk of bias in two or more domains and we ten trials had a high risk of bias due to lack of blinding (placebo was not used in the control arm. Overall, the certainty of evidence was moderate to high, but it was downgraded for IVH due to indirectness; for developmental delay due to risk of bias and for maternal adverse outcomes (death, chorioamnionitis and endometritis) due to imprecision. Neonatal/child outcomes Antenatal corticosteroids reduce the risk of: - perinatal death (risk ratio (RR) 0.85, 95% confidence interval (CI) 0.77 to 0.93; 9833 infants; 14 studies; high-certainty evidence; 2.3% fewer, 95% CI 1.1% to 3.6% fewer), - neonatal death (RR 0.78, 95% CI 0.70 to 0.87; 10,609 infants; 22 studies; high-certainty evidence; 2.6% fewer, 95% CI 1.5% to 3.6% fewer), - respiratory distress syndrome (RR 0.71, 95% CI 0.65 to 0.78; 11,183 infants; studies = 26; high-certainty evidence; 4.3% fewer, 95% CI 3.2% to 5.2% fewer). Antenatal corticosteroids probably reduce the risk of IVH (RR 0.58, 95% CI 0.45 to 0.75; 8475 infants; 12 studies; moderate-certainty evidence; 1.4% fewer, 95% CI 0.8% to1.8% fewer), and probably have little to no effect on birthweight (mean difference (MD) -14.02 g, 95% CI -33.79 to 5.76; 9551 infants; 19 studies; high-certainty evidence). Antenatal corticosteroids probably lead to a reduction in developmental delay in childhood (RR 0.51, 95% CI 0.27 to 0.97; 600 children; 3 studies; moderate-certainty evidence; 3.8% fewer, 95% CI 0.2% to 5.7% fewer). Maternal outcomes Antenatal corticosteroids probably result in little to no difference in maternal death (RR 1.19, 95% CI 0.36 to 3.89; 6244 women; 6 studies; moderate-certainty evidence; 0.0% fewer, 95% CI 0.1% fewer to 0.5% more), chorioamnionitis (RR 0.86, 95% CI 0.69 to 1.08; 8374 women; 15 studies; moderate-certainty evidence; 0.5% fewer, 95% CI 1.1% fewer to 0.3% more), and endometritis (RR 1.14, 95% CI 0.82 to 1.58; 6764 women; 10 studies; moderate-certainty; 0.3% more, 95% CI 0.3% fewer to 1.1% more) The wide 95% CIs in all of these outcomes include possible benefit and possible harm. AUTHORS' CONCLUSIONS:Evidence from this updated review supports the continued use of a single course of antenatal corticosteroids to accelerate fetal lung maturation in women at risk of preterm birth. Treatment with antenatal corticosteroids reduces the risk of perinatal death, neonatal death and RDS and probably reduces the risk of IVH. This evidence is robust, regardless of resource setting (high, middle or low). Further research should focus on variations in the treatment regimen, effectiveness of the intervention in specific understudied subgroups such as multiple pregnancies and other high-risk obstetric groups, and the risks and benefits in the very early or very late preterm periods. Additionally, outcomes from existing trials with follow-up into childhood and adulthood are needed in order to investigate any longer-term effects of antenatal corticosteroids. We encourage authors of previous studies to provide further information which may answer any remaining questions about the use of antenatal corticosteroids without the need for further randomised controlled trials. Individual patient data meta-analyses from published trials are likely to provide answers for most of the remaining clinical uncertainties.
[Moderate preterm birth 34-37 weeks: Description of immediate neonatal causes and consequences in a level 2 maternity].
Valery S,Picone O,Coatantiec Y,Frati A,Labrousse C,Ayoubi J-M
Gynecologie, obstetrique & fertilite
OBJECTIVES:In France, 75% of annual preterm births happen between 34 and 36 weeks+6 days. This study's goal is to describe the main causes and short-term consequences. METHODS:Two hundred and ninety-seven computerized files of patients who gave birth between 34 and 36 weeks+6 days at the hospital Foch's maternity were analyzed retrospectively. Descriptive statistical analysis was done with XLSTAT 2008. RESULTS:Among the 6028 births, 4.9% happened between 34 and 36 weeks+6 days and 43.1% of these births were medically induced. The two main causes of induced late preterm birth were: pre-eclampsia (28.9%) and premature rupture of membranes (25%). In spontaneous deliveries, newborns less often require respiratory support at birth (17.2% vs 31%; P=0.02) and are significantly less likely to be hospitalized in neonatology (54% vs 72.3%; P<0.01). C-section rates (71.1% vs 17.75%; P<0.01) and post-partum hemorrhages' probability (10.2% vs 3%; P<0.01) are significantly higher than for medically induced deliveries. CONCLUSION:Better knowledge of late prematurity causes and consequences would help limit medically induced births after 34 weeks.
The cause of birth is associated with neonatal prognosis in late preterm singletons.
Bénin Amélie,Blanc Matthieu,Chollat Clément,Jarreau Pierre-Henri,Goffinet François,Tsatsaris Vassilis,Delorme Pierre
Journal of gynecology obstetrics and human reproduction
INTRODUCTION:Recent studies have shown that the cause of very preterm births may be related to neonatal morbidity and mortality. Even though these risks are lower among late preterm births, this group accounts for the vast majority of all preterm births. The objective of this study was to evaluate the relation of neonatal morbidity and mortality to the cause of late preterm birth. MATERIALS AND METHODS:This retrospective observational cohort study included all women who gave birth to liveborn singletons from 34 to 36 weeks+6 days of gestation in a French level III maternity hospital in the 5-year period 2013-2017. The causes of preterm delivery were divided into 6 mutually exclusive groups. The main outcome was a composite neonatal morbidity criterion, defined by at least one among the following criteria: neonatal respiratory distress, neurological complications, neonatal sepsis, severe necrotizing enterocolitis, and neonatal hypoglycemia. We analyzed the association between cause of preterm delivery and neonatal morbidity after adjustment for gestational age and antenatal corticosteroid therapy. The reference group was preterm labor, defined by spontaneous preterm labor with intact membranes. RESULTS:During the study period, there were a total of 27 110 births, including 1114 singleton births at 34 to 36 weeks of gestation + 6 days (4.1%). Among the 968 late preterm births included, the risk of neonatal morbidity in the group with preterm premature rupture of membranes (PPROM) was similar to that in the preterm labor (reference) group: adjusted odds ratio (aOR) 1.2 (95% CI, 0.8-1.8). All the other causes of late preterm birth were associated with a higher risk of neonatal morbidity than the reference group: aOR 2.0 [95% CI, 1.1-3.5] for hypertensive disorders without suspected fetal growth restriction (FGR) (9.1% of cases), aOR 2.4 [95% CI, 1.4-4.2] for hypertensive disorders with suspected FGR (8.9%), aOR 4.2 [95% CI, 2.2-8.0] for suspected FGR without hypertensive disorders (5.8%), and aOR 4.4 [95% CI, 2.2-8.8] for vaginal bleeding related to abnormal placental insertion (4.7%). CONCLUSION:Among infants born from 34 to 36 weeks + 6 days of gestation, PPROM and preterm labor had similar risks of neonatal morbidity, while the other causes were associated with a risk of neonatal morbidity at least twice that with preterm labor.
Increasing rates of prematurity and epidemiology of late preterm birth.
Cheong Jeanie L Y,Doyle Lex W
Journal of paediatrics and child health
Preterm birth rates in Australia have risen in the last two decades, mostly accounted for by the rise in late preterm births. Late preterm births (34-36 weeks) comprise 70% of all preterm births, which translates to approximately 16,000 births annually in Australia. The precise causes for this trend are unclear; however, possible aetiologies include increasing maternal age, increased use of artificial reproductive technologies and increased multiple births. Compared with term-born children, late preterm children not only have increased mortality and in-hospital morbidity including respiratory difficulties, but also long-term cognitive, school performance, behaviour and psychiatric problems. The potential public health and educational burden of late preterm birth is considerable. More research is required in this area to understand the risk factors for late preterm birth and to help identify those children at highest risk of developmental deficits.
Maternal obesity classes, preterm and post-term birth: a retrospective analysis of 479,864 births in England.
Slack Emma,Best Kate E,Rankin Judith,Heslehurst Nicola
BMC pregnancy and childbirth
BACKGROUND:Preterm (< 37 weeks gestation) and post-term birth (≥42 weeks gestation) are associated with increased morbidity and mortality for mother and infant. Obesity (body mass index (BMI) ≥30 kg/m) is increasing in women of reproductive age. Maternal obesity has been associated with adverse pregnancy outcomes including preterm and post-term birth. However, the effect sizes vary according to the subgroups of both maternal BMI and gestational age considered. The aim of this retrospective analysis was to determine the association between maternal obesity classes and gestational age at delivery. METHODS:A secondary data analysis of 13 maternity units in England with information on 479,864 singleton live births between 1990 and 2007. BMI categories were: underweight (< 18.5 kg/m), recommended weight (18.5-24.9 kg/m), overweight (25.0-29.9 kg/m) and obesity classes I (30.0-34.9 kg/m), II (35.0-39.9 kg/m), IIIa (40-49.9 kg/m) and IIIb (≥50 kg/m). Gestational age at delivery categories were: Gestational age at delivery (weeks): extreme preterm (20-27), very preterm (28-31), moderately preterm (32-36), early term (37, 38), full term (39-40), late term (41) and post-term (≥42). The adjusted odds of births in each gestational age category (compared to full-term birth), according to maternal BMI categories were estimated using multinomial logistic regression. Missing data were estimated using multiple imputation with chained equations. RESULTS:There was a J-shaped association between the absolute risk of extreme, very and moderate preterm birth and BMI category, with the greatest effect size for extreme preterm. The absolute risk of post-term birth increased monotonically as BMI category increased. The largest effect sizes were observed for class IIIb obesity and extreme preterm birth (adjusted OR 2.80, 95% CI 1.31-5.98). CONCLUSION:Women with class IIIb obesity have the greatest risks for inadequate gestational age. Combining obesity classes does not accurately represent risks for many women as it overestimates the risk of all preterm and post-term categories for women with class I obesity, and underestimates the risk for women in all other obesity classes.
Neonatal morbidity associated with late preterm and early term birth: the roles of gestational age and biological determinants of preterm birth.
Brown Hilary K,Speechley Kathy Nixon,Macnab Jennifer,Natale Renato,Campbell M Karen
International journal of epidemiology
BACKGROUND:The aim of this study was to elucidate the role of gestational age in determining the risk of neonatal morbidity among infants born late preterm (34-36 weeks) and early term (37-38 weeks) compared with those born full term (39-41 weeks) by examining the contribution of gestational age within the context of biological determinants of preterm birth. METHODS:This was a retrospective cohort study. The sample included singleton live births with no major congenital anomalies, delivered at 34-41 weeks of gestation to London-Middlesex (Canada) mothers in 2002-11. Data from a city-wide perinatal database were linked with discharge abstract data. Multivariable models used modified Poisson regression to directly estimate adjusted relative risks (aRRs). The roles of gestational age and biological determinants of preterm birth were further examined using mediation and moderation analyses. RESULTS:Compared with infants born full term, infants born late preterm and early term were at increased risk for neonatal intensive care unit triage/admission [late preterm aRR=6.14, 95% confidence interval (CI) 5.63, 6.71; early term aRR=1.54, 95% CI 1.41, 1.68] and neonatal respiratory morbidity (late preterm aRR=6.16, 95% CI 5.39, 7.03; early term aRR=1.46, 95% CI 1.29, 1.65). The effect of gestational age was partially explained by biological determinants of preterm birth acting through gestational age. Moreover, placental ischaemia and other hypoxia exacerbated the effect of gestational age on poor outcomes. CONCLUSIONS:Poor outcomes among infants born late preterm and early term are not only due to physiological immaturity but also to biological determinants of preterm birth acting through and with gestational age to produce poor outcomes.
Respiratory consequences of late preterm birth.
Pike Katharine C,Lucas Jane S A
Paediatric respiratory reviews
In developed countries most preterm births occur between 34 and 37 weeks' gestation. Deliveries during this 'late preterm' period are increasing and, since even mild prematurity is now recognised to be associated with adverse health outcomes, this presents healthcare challenges. Respiratory problems associated with late preterm birth include neonatal respiratory distress, severe RSV infection and childhood wheezing. Late preterm birth prematurely interrupts in utero lung development and is associated with maternal and early life factors which adversely affect the developing respiratory system. This review considers 1) mechanisms underlying the association between late preterm birth and impaired respiratory development, 2) respiratory morbidity associated with late preterm birth, particularly long-term outcomes, and 3) interventions which might protect respiratory development by addressing risk factors affecting the late preterm population, including maternal smoking, early life growth restriction and vulnerability to viral infection.
[Late preterm : high risk newborns despite appearances].
Snyers D,Lefebvre C,Viellevoye R,Rigo V
Revue medicale de Liege
Late preterm infants are born between 34 weeks of amenorrhea and 36 weeks 6 days. Late preterms represent the largest proportion of premature infants (about 75 %). Late prematurity is increasing in recent decades. While studies initially focused on mortality and morbidity related to very preterm birth, the late preterms have been the subject of increased attention over the past 15 years. Late preterm infants have an increased risk of respiratory complications, infections, feeding problems, hypothermia and hypoglycemia. Neonatal, infant and during adulthood mortalities are significantly higher in late preterm than in term infants. In addition, late preterm infants carry an increased risk of long-term morbidities, such as neurodevelopmental delay, cerebral palsy, chronic respiratory or metabolic diseases. This review highlights the evidence that late preterm infants are high risk newborns and require adapted follow-up.