The effect of gestational age on neonatal outcome in low-risk singleton term deliveries (original) (raw)
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Gestational age and 1-year hospital admission or mortality: a nation-wide population-based study
BMC Pediatrics, 2017
Background: Describe the 1-year hospitalization and in-hospital mortality rates, in infants born after 31 weeks of gestational age (GA). Methods: This nationwide population-based study used the French medico-administrative database to assess the following outcomes in singleton live-born infants (32-43 weeks) without congenital anomalies (year 2011): neonatal hospitalization (day of life 1-28), post-neonatal hospitalization (day of life 29-365), and 1-year in-hospital mortality rates. Marginal models and negative binomial regressions were used. Results: The study included 696,698 live-born babies. The neonatal hospitalization rate was 9.8%. Up to 40 weeks, the lower the GA, the higher the hospitalization rate and the greater the likelihood of requiring the highest level of neonatal care (both p < 0.001). The relative risk adjusted for sex and pregnancy-related diseases (aRR) reached 21.1 (95% confidence interval [CI]: 19.2-23.3) at 32 weeks. The post-neonatal hospitalization rate was 12.1%. The raw rates for post-neonatal hospitalization fell significantly from 32-40 and increased at 43 weeks and this persisted after adjustment (aRR = 3.6 [95% CI: 3.3-3.9] at 32 and 1.5 [95% CI: 1.1-1.9] at 43 compared to 40 weeks). The main causes of post-neonatal hospitalization were bronchiolitis (17.2%), gastroenteritis (10.4%) ENT diseases (5.4%) and accidents (6.2%). The in-hospital mortality rate was 0.85‰, with a significant decrease (p < 0.001) according to GA at birth (aRR = 3.8 [95% CI: 2.4-5.8] at 32 and 6.6 [95% CI: 2.1-20.9] at 43, compared to 40 weeks. Conclusion: There's a continuous change in outcome in hospitalized infants born above 31 weeks. Birth at 40 weeks gestation is associated with the lowest 1-year morbidity and mortality.
Role of gestational age and maternal biological factors in early term neonatal morbidity
Boletín Médico del Hospital Infantil de México
Background: The morbidity of early-term newborns (ETNBs) is associated with the immaturity of their organs and maternal biological factors (MBF). In this study, we determined the relationship between MBF and early-term birth. In addition, we assessed the role of gestational age (GA) and MBF in the morbidity of ETNBs compared with full-term newborns (FTNBs). Methods: This retrospective cohort included ETNBs and FTNBs. The frequency of morbidities was compared between groups stratified by GA with the X 2 test or Fisher's exact test. The association of MBF with GA and morbidity was calculated using binomial regression models between the variables that correlated with the morbidity of the ETNBs using Spearman's correlation. A significance level of 5% was estimated for all analyses. Results: The probability of morbidity at birth for ETNBs was 1.9-fold higher than for FTNBs (37.5% vs. 19.9%), as they required more admission to the neonatal unit and more days of hospitalization; the most frequent pathology was jaundice. The MBF associated with early term birth were hypertensive disorders of pregnancy (
International Journal of Contemporary Pediatrics, 2017
Background: The Aim of this study was to see the effect of gender and gestational age on early morbidities and mortalities of extremely low birth weight neonates.Methods: It was cross section retrospective. This retrospective study over a period of 5 years from June 2009 to May 2014 in a tertiary level teaching hospital. All the ELBW neonates admitted during the study period were recruited. Moving in a retrospective manner we collected previous case records relevant to our study from the institute and then categorized our data on the basis of gestational age and gender, then we compared and analysed our data on the basis of incidence of mortalities and morbidities and the effect of gender and gestational age on it.Results: Out of 115 ELBW neonates 61(53%) were born at ≤ 28 weeks, 26 (22%) were born between 29 to 31 weeks and 28(24%) babies were born at 32 to 37 weeks. The most common maternal risk factors responsible for ELBW deliveries were Pregnancy induced hypertension 27 (23%) f...
Preterm neonatal morbidity and mortality by gestational age: a contemporary cohort
American Journal of Obstetrics and Gynecology, 2016
Background-Although preterm birth less than 37 weeks gestation is the leading cause of neonatal morbidity and mortality in the United States, the majority of data regarding preterm neonatal outcomes come from older studies, and many reports have been limited to only very preterm neonates. Delineation of neonatal outcomes by delivery gestational age is needed to further clarify the continuum of mortality and morbidity frequencies among preterm neonates. Objective-We sought to describe the contemporary frequencies of neonatal death, neonatal morbidities, and neonatal length of stay across the spectrum of preterm gestational ages. Study Design-Secondary analysis of an obstetric cohort of 115,502 women and their neonates who were born in 25 hospitals nationwide, 2008-2011. All live born non-anomalous singleton preterm (23.0-36.9 weeks of gestation) neonates were included in this analysis. The frequency of neonatal death, major neonatal morbidity (intraventricular hemorrhage grade III/IV, seizures, hypoxic-ischemic encephalopathy, necrotizing enterocolitis stage II/III, bronchopulmonary dysplasia, persistent pulmonary hypertension), and minor neonatal morbidity (hypotension requiring treatment, intraventricular hemorrhage grade 1/2, necrotizing enterocolitis stage 1, respiratory distress syndrome, hyperbilirubinemia requiring treatment) were calculated by delivery gestational age; each neonate was classified once by the worst outcome they met criteria for. Results-8,334 deliveries met inclusion criteria. There were 119 neonatal deaths (1.4%). 657 (7.9%) neonates had major morbidity, 3,136 (37.6%) had minor morbidity, and 4,422 (53.1%) survived without any of the studied morbidities. Deaths declined rapidly with each advancing week of gestation. This decline in death was accompanied by an increase in major neonatal morbidity, which peaked at 54.8% at 25 weeks of gestation. As frequencies of death, and major neonatal morbidity fell, minor neonatal morbidity increased, peaking at 81.7% at 31 weeks of gestation. The frequency of all morbidities fell beyond 32 weeks. Neonatal length of hospital stay decreased significantly with each additional completed week of pregnancy; among babies delivered from 26 to 32 weeks of gestation, each additional week in utero reduced the subsequent length of neonatal hospitalization by a minimum of 8 days. The median post-menstrual age at discharge nadired at 35.7 weeks post-menstrual age for babies born at 32-33 weeks of gestation. Conclusions-Our data show that there is a continuum of outcomes, with each additional week for gestation conferring survival benefit while reducing the length of initial hospitalization. These contemporary data can be useful for patient counseling regarding preterm outcomes.
On the limit of viability extremely low gestational age at birth
Acta médica portuguesa, 2011
Survival is not an adequate measure of success when managing preterm infants < 24 weeks gestational age (GA). To evaluate neonatal morbidity, survival rate and outcome of preterm infants < 24 weeks GA at birth, in our Neonatal Intensive Care Unit. Retrospective chart review, 1996-2009. Collected data included neonatal morbidity and mortality, follow-up at the outpatient department regarding to medical problems and neurodevelopmental and behavioural outcomes. 53 preterm neonates (27 male/ 26 female) were included; weight at birth: 630 g (360-870); gestational age: 23.5 wks (22-24); outborn: 9 (17%); any antenatal steroid: 57%. Neonatal morbidity included: hypotension 68%; respiratory distress syndrome: 98%; pneumothorax: 11%; patent ductus arteriosus: 42%; noso sepsis: 72%; necrotizing enterocolitis (>2A): 54%; intraventricular hemorrhage (III+IV): 34%; retinopathy of prematurity (>2): 20%; bronchopulmonary dysplasia: 71%. Mortality rate was 87% (n = 46). Antenatal steroi...
Neonatal outcome associated with singleton birth at 34-41 weeks of gestation
International Journal of Epidemiology, 2010
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.
Adverse neonatal outcomes: examining the risks between preterm, late preterm, and term infants
American Journal of Obstetrics and Gynecology, 2008
OBJECTIVE: There is a relative paucity of data regarding neonatal outcomes in the late preterm cohort (34 to 36 6/7 weeks). This study sought to assess differences in adverse outcomes between infants delivering 32 to 33 6/7, 34 to 36 6/7 weeks, and 37 weeks or later. STUDY DESIGN: Data were collected as part of a retrospective cohort study of preterm labor patients (2002)(2003)(2004)(2005). Patients delivering 32 weeks or later were included (n ϭ 264). The incidence of adverse outcomes was assessed. Significant associations between outcomes and gestational age at delivery were determined using 2 analyses and Poisson regression modeled cumulative incidence and controlled for confounders. RESULTS: Late preterm infants have increased risk of adverse outcomes, compared with term infants. Controlling for confounders, there was a 23% decrease in adverse outcomes with each week of advancing gestational age between 32 and 39 completed weeks (relative risk 0.77, P Ͻ .001, 95% confidence interval, 0.71-0.84).
Short-term Neonatal Outcome in Low-Risk, Spontaneous, Singleton, Late Preterm Deliveries
Obstetrics & Gynecology, 2009
To estimate the effect of gestational age on short-term neonatal morbidity in cases of spontaneous, low-risk singleton late preterm deliveries and to identify predictors of adverse neonatal outcome. METHODS: This was a retrospective study of all spontaneous, low-risk late preterm deliveries (34 0/7 to 36 6/7 weeks of gestation) during the years 1997 to 2006 (n.)874,2؍ Multiple gestations and pregnancies complicated by preterm premature rupture of membranes (PROM) or maternal or fetal complications were excluded. Short-term neonatal outcome was compared with a control group of full-term deliveries in a 3:1 ratio (n.)434,7؍ Logistic regression analysis was used to identify risk factors for neonatal morbidity among late preterm infants. RESULTS: Compared with full-term infants, spontaneous late preterm delivery was independently associated with an increased risk of neonatal morbidity, including respiratory distress syndrome (4.2% compared with 0.1%, P<.001), sepsis (0.4% compared with 0.04%, P<.001), intraventricular hemorrhage (0.2% compared with 0.02%, P<.001), hypoglycemia (6.8% compared with 0.4%, P<.001), and jaundice requiring phototherapy (18% compared with 2.5%, P<.001). Cesarean delivery (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.6-2.6), male sex (OR 1.4, 95% CI 1.1-1.8), and multiparity (OR 2.2, 95% CI 1.7-2.8) were independent risk factors for neonatal respiratory morbidity in cases of late preterm deliveries. The relationship between gestational age and neonatal morbidity was of continuous nature with a nadir at about 39 weeks rather than a term-preterm threshold phenomenon and was unrelated to birth weight. CONCLUSION: Late prematurity is associated with significant neonatal morbidity in cases of spontaneous lowrisk singleton deliveries. This information is important for appropriate counseling and should stimulate efforts to decrease the rate of late preterm deliveries.
American Journal of Obstetrics and Gynecology, 1992
OBJECTIVES: This study details the incidence, by gestational age and birth weight, of specific neonatal morbidities in singleton neonates without major congenital anomalies. STUDY DESIGN: Data were prospectively collected on all deliveries at five tertiary centers in the United States during the years 1983 through 1986. Pregnancies were meticulously dated and the gestational ages of the neonates at delivery were confirmed by Dubowitz score. RESULTS: The incidence of respiratory distress syndrome gradually decreases with increasing gestational age until 36 weeks. A marked decrease in the incidence of necrotizing enterocolitis, patent ductus arteriosus, intraventricular hemorrhage, and sepsis occurs after 32 completed weeks. The number of days of mechanical ventilation for respiratory distress syndrome and newborn stay in the tertiary care facility also were significantly reduced after 32 weeks.
Obsgyne Review: Journal of Obstetric and Gynecology, 2020
Objectives: To study the maternal and fetal outcome and complications in post-term pregnancies and to compare them with an equal number of term pregnancies. Materials and Methods: The study was conducted in the department of OBG, AIMS, B.G. Nagara. 50 cases of post-term singleton pregnancies with Gestational age > 42 weeks, 18-35 years of age with reliable dates and no obstetric or medical complications were the study group. The control group comprised of 50 singleton pregnancies between 37 and 42 weeks, 18-35 years of age with reliable dates and no obstetric or medical complications. The maternal morbidity was based on mode of delivery, operative interventions, injuries, PPH and Fetal morbidity was based on number of fetuses with meconium staining of amniotic fluid, NICU admissions, asphyxia, metabolic complications. Results: Post-term pregnancy was found to be associated with increased morbidity, In the mother, labor had to be induced in a significant number of cases (p 0.070) since a large number of them had a low Bishop's score (p=0.086). Operative interference in the form of LSCS was positively associated with post-term (p=0.166) with causes varying from the failure of induction, prolonged labor. fetal distress, macrosomia and oligohydramnios (p <004). Perinatal morbidity was significantly associated with Post-term (32.0% vs 6.06) with P<0.001 due to birth asphyxia, meconium aspiration syndrome, the incidence of Meconium stained liquor being 60% (P-0.001). Conclusion: The maternal and fetal morbidity is significantly increased after 42 weeks. There is a great need for accurate dating of pregnancy. The importance of induction of labor at 41 weeks and definitely not beyond 42 weeks cannot be sufficiently stressed.