Neonatal Outcomes Differ after Spontaneous and Indicated Preterm Birth

Molly J. Stout; Devyn Demaree; Emily Merfeld; Methodius G. Tuuli; Jennifer A. Wambach; F. Sessions Cole; Alison G. Cahill

doi:10.1055/s-0037-1608804

American Journal of Perinatology, Inhaltsverzeichnis

Am J Perinatol 2018; 35(05): 494-502
DOI: 10.1055/s-0037-1608804

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Neonatal Outcomes Differ after Spontaneous and Indicated Preterm Birth

Autor*innen

Molly J. Stout

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis Children's Hospital, St. Louis, Missouri
Devyn Demaree^*

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis Children's Hospital, St. Louis, Missouri
Emily Merfeld^*

²Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis Children's Hospital, St. Louis, Missouri
Methodius G. Tuuli

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis Children's Hospital, St. Louis, Missouri
Jennifer A. Wambach

²Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis Children's Hospital, St. Louis, Missouri
F. Sessions Cole

²Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis Children's Hospital, St. Louis, Missouri
Alison G. Cahill

¹Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis Children's Hospital, St. Louis, Missouri

Abstract

Objective Preterm birth (PTB) at <37 weeks of gestation complicates 10% of pregnancies and requires accurate counseling regarding anticipated neonatal outcomes. PTB classification as spontaneous or indicated is commonly used to cluster PTB into subtypes, but whether neonatal outcomes differ by PTB subtype is unknown. We tested the hypothesis that neonatal morbidity differs based on subtype of PTB.

Methods We performed a retrospective cohort study of live-born, non-anomalous preterm infants from 2004 to 2008. Spontaneous PTB was defined as PTB from spontaneous preterm labor or preterm rupture of membranes. Indicated PTB was defined as PTB from any maternal or fetal medical complication necessitating delivery. The primary outcome was a composite of early respiratory morbidity. Secondary outcomes included late composite respiratory morbidity and other neonatal morbidities.

Results Of 1,223 preterm neonates, 60.9% were born after spontaneous PTB and 30.1% after indicated PTB. Composite early respiratory morbidity was significantly higher after indicated PTB versus spontaneous PTB (1.3, 95% confidence interval [CI] 1.2–1.4). Composite late respiratory morbidity (1.8, 95% CI 1.3–2.3) and neonatal death (2.8, 95% CI 1.5–5.1) were also significantly higher after indicated PTB versus spontaneous PTB.

Conclusion Neonatal respiratory outcomes and death differ according to PTB subtype. PTB subtype should be considered while counseling families and anticipating neonatal outcomes after PTB.

Keywords

spontaneous preterm birth - indicated preterm birth - neonatal outcomes

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Referenzen

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