Morbidity and Discharge Timing of Late Preterm Newborns

Abstract

Late preterm newborns (LPNs), those with gestational ages (GAs) between 34 weeks and 36 weeks 6 days, account for 70% of preterm births. Because they have a mature appearance and are often cared for in a well baby nursery (WBN), parents may anticipate that the nursery course will be similar to that of a term infant and that their newborn will be discharged with his/her mother. How frequently their hospitalizations are prolonged beyond that of their mothers and the morbidities associated with prolonged hospitalization (PH) have not been well described. The objectives of the study were to (1) determine the proportion of LPNs with a PH and (2) describe the most common morbidities in LPNs and identify those associated with PH. The authors conducted retrospective chart reviews of the neonatal courses of LPNs born between December 2002 and April 2007 at the University of Utah Hospital. They compared maternal and newborn discharge dates to determine the proportion of LPNs with a PH and calculated frequencies of conditions and interventions indicating morbidity and identified associations between each of the conditions/interventions and PH. Of 235 LPNs, 94 (40%) had a PH; 75% of 34-week LPNs had a PH compared with 50% of those with GAs of 35 weeks and 25% of those with GAs of 36 weeks. The most common conditions/interventions were an oxygen need, phototherapy for jaundice, and hypothermia requiring an isolette. A need for nasogastric feeding and antibiotic administration for >3 days was consistently associated with a PH. LPNs whose only intervention was phototherapy for jaundice or IV antibiotics for <3 days did not have a PH. As a group, two thirds of LPNs experienced one or more conditions/interventions indicating morbidity, and 40% had a PH. Both were much more common in LPNs with GAs of 34 weeks compared with LPNs with GAs of 36 weeks. Nursery clinicians should counsel parents of LPNs regarding the likely possibility of morbidity and PH.

Keywords

gestational age neonatal morbidity premature infants

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References

Davidoff MJ , Dias T. , Damus K. , et al. Changes in the gestational age distribution among U.S. singleton births: impact on rates of late preterm birth, 1992 to 2002. Semin Perinatol. 2006;30:8-15.

Kramer MS , Demissie K. , Yang H. , Platt RW , Sauve R. , Liston R. The contribution of mild and moderate preterm birth to infant mortality: Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System . JAMA. 2000;284:843-849.

Tomashek KM , Shapiro-Mendoza CK , Davidoff MJ , Petrini JR Differences in mortality between late-preterm and term singleton infants in the United States, 1995-2002. J Pediatr. 2007 ;151:450-456.

Young PC , Glasgow TS , Li X. , Guest-Warnick G. , Stoddard G. Mortality of late-preterm (near-term) newborns in Utah. Pediatrics . 2007;119:e659-e665.

Khashu M. , Narayanan M. , Bhargava S. , Osiovich H. Perinatal outcomes associated with preterm birth at 33 to 36 weeks’ gestation: a population-based cohort study. Pediatrics. 2009;123:109-113.

Vachharajani AJ , Dawson JG Short-term outcomes of late preterms: an institutional experience. Clin Pediatr ( Phila). 2009;48:383-388.

Wang ML , Dorer DJ , Fleming MP , Catlin EA Clinical outcomes of near-term infants. Pediatrics . 2004;114:372-376.

McIntire DD , Leveno KJ Neonatal mortality and morbidity rates in late preterm births compared with births at term. Obstet Gynecol . 2008;111:35-41.

Shapiro-Mendoza CK , Tomashek KM , Kotelchuck M. , et al. Effect of late-preterm birth and maternal medical conditions on newborn morbidity risk. Pediatrics. 2008;121:e223-e232.

10.

Bastek JA , Sammel MD , Pare E. , Srinivas SK , Posencheg MA , Elovitz MA Adverse neonatal outcomes: examining the risks between preterm, late preterm, and term infants. Am J Obstet Gynecol. 2008 ;199:367 e1-e8.

11.

Raju TNK , Higgins RD , Stark AD , Leveno KJ Summary of the workshop sponsored by the National Institute of Child Health and Human Development Optimizing Care and Outcome for Late-Preterm (Near-Term) Infants. Pediatrics. 2006;118:1207-1214.

12.

Effect of antenatal steroids for fetal maturation on perinatal outcomes. NIH Consens Statement. 1994;12:1-24.

13.

Cuzick J. A Wilcoxon-type test for trend. Stat Med. 1985; 4:87-90.

14.

Lubow JM , How HY , Habli M. , Maxwell R. , Sibai BM Indications for delivery and short-term neonatal outcomes in late preterm as compared with term births. Am J Obstet Gynecol. 2009;200:e30-e33.

15.

Escobar GJ , Clark RH , Greene JD Short-term outcomes of infants born at 35 and 36 weeks gestation: we need to ask more questions. Semin Perinatol. 2006 ;30:28-33.

16.

Ishiguro A. , Namai Y. , Ito YM Managing "healthy" late preterm infants. Pediatr Int. 2009;51:720-725.

17.

Clark RH The epidemiology of respiratory failure in neonates born at an estimated gestational age of 34 weeks or more. J Perinatol. 2005 ;25:251-257.

18.

Crnic KA , Ragozin AS , Greenberg MT , Robinson NM , Basham RB Social interaction and developmental competence of preterm and full-term infants during the first year of life. Child Dev. 1983;54:1199-1210.

19.

Forcada-Guex M. , Pierrehumbert B. , Borghini A. , Moessinger A. , Muller-Nix C. Early dyadic patterns of mother-infant interactions and outcomes of prematurity at 18 months . Pediatrics. 2006;118:e107-e114.

20.

Greene JG , Fox NA , Lewis M. The relationship between neonatal characteristics and three-month mother-infant interaction in high-risk infants. Child Dev . 1983;54:1286-1296.

21.

Jeffcoate JA , Humphrey ME , Lloyd JK Disturbance in parent-child relationship following preterm delivery. Dev Med Child Neurol . 1979 ;21:344-352.

22.

Miles MS , Holditch-Davis D. , Schwartz TA , Scher M. Depressive symptoms in mothers of prematurely born infants. J Dev Behav Pediatr. 2007;28:36-44.

23.

Muller-Nix C. , Forcada-Guex M. , Pierrehumbert B. , Jaunin L. , Borghini A. , Ansermet F. Prematurity, maternal stress and mother-child interactions. Early Hum Dev . 2004;79:145-158.

24.

Green M. , Solnit AJ Reactions to the threatened loss of a child: a vulnerable child syndrome: pediatric management of the dying child, part III. Pediatrics . 1964;34:58-66.

25.

Pulver LS , Guest-Warnick G. , Stoddard GJ , Byington CL , Young PC Weight for gestational age affects the mortality of late preterm infants . Pediatrics. 2009;123:e1072-e1077.