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DOI: 10.1055/s-0033-1347364
Impact of Late Preterm and Early Term Infants on Canadian Neonatal Intensive Care Units
Publication History
13 February 2013
21 April 2013
Publication Date:
31 May 2013 (online)
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Abstract
Objective To examine the short-term morbidities, mortality, and use of neonatal intensive care unit (NICU) resources for late preterm, early term, and term infants.
Study Design Infants born between 34 and 40 weeks of gestation and admitted to a Canadian NICU in 2010 were designated late preterm (340/7 to 366/7 weeks), early term (370/7 to 386/7 weeks), or term (390/7 to 406/7 weeks). Mortality, short-term morbidities, and resource utilization were compared between the three groups using chi-square tests and analysis of variance.
Results Among 6,636 included infants, 44.2% (n = 2,935) were late preterm, 26.2% (n = 1,737) early term, and 29.6% (n = 1,964) term. Term infants were more likely to require resuscitation at birth and had lower Apgar scores than late preterm and early term infants (p < 0.001). Length of stay and need for respiratory support decreased with increasing gestational age; however, the proportion of hospital days that intensive care was required increased.
Conclusion The greatest impact of late preterm infants is on NICU bed occupancy, whereas for term infants it is on intensity of care. Early term infants experience greater rates of some complications than term, demonstrating that risk persists for these infants. These findings have important implications for NICU resource planning and practice.
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References
- 1 Kramer MS, Demissie K, Yang H, Platt RW, Sauvé R, Liston R. Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System. The contribution of mild and moderate preterm birth to infant mortality. JAMA 2000; 284: 843-849
- 2 Loftin RW, Habli M, Snyder CC, Cormier CM, Lewis DF, Defranco EA. Late preterm birth. Rev Obstet Gynecol 2010; 3: 10-19
- 3 Ramachandrappa A, Jain L. Health issues of the late preterm infant. Pediatr Clin North Am 2009; 56: 565-577
- 4 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 , e1
- 5 Gyamfi-Bannerman C. The scope of the problem: the epidemiology of late preterm and early-term birth. Semin Perinatol 2011; 35: 246-248
- 6 Hibbard JU, Wilkins I, Sun L , et al; Consortium on Safe Labor. Respiratory morbidity in late preterm births. JAMA 2010; 304: 419-425
- 7 Kamath BD, Marcotte MP, DeFranco EA. Neonatal morbidity after documented fetal lung maturity in late preterm and early term infants. Am J Obstet Gynecol 2011; 204: e1-e8
- 8 Reddy UM, Ko CW, Raju TN, Willinger M. Delivery indications at late-preterm gestations and infant mortality rates in the United States. Pediatrics 2009; 124: 234-240
- 9 Kitsommart R, Janes M, Mahajan V , et al. Outcomes of late-preterm infants: a retrospective, single-center, Canadian study. Clin Pediatr (Phila) 2009; 48: 844-850
- 10 Shah P, Lee S, Yoon W, Chan P. and Members of the Report Review Committee, Canadian Neonatal Network Annual Report. 2010 . Available at: http://www.canadianneonatalnetwork.org . Accessed May 2012
- 11 Jefferies AL, Lyons ER, Shah PS, Shah V. Impact of late preterm birth on neonatal intensive care resources in a tertiary perinatal centre. Am J Perinatol 2012; , Dec 19 epub.
- 12 Lee SK, McMillan DD, Ohlsson A , et al. Variations in practice and outcomes in the Canadian NICU network: 1996–1997. Pediatrics 2000; 106: 1070-1079
- 13 Kramer MS, Platt RW, Wen SW , et al; Fetal/Infant Health Study Group of the Canadian Perinatal Surveillance System. A new and improved population-based Canadian reference for birth weight for gestational age. Pediatrics 2001; 108: E35
- 14 Richardson DK, Corcoran JD, Escobar GJ, Lee SK. SNAP-II and SNAPPE-II: simplified newborn illness severity and mortality risk scores. J Pediatr 2001; 138: 92-100
- 15 Bell MJ, Ternberg JL, Feigin RD , et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187: 1-7
- 16 Peacock JL, Marston L, Marlow N, Calvert SA, Greenough A. Neonatal and infant outcome in boys and girls born very prematurely. Pediatr Res 2012; 71: 305-310
- 17 Martin JA, Kung HC, Mathews TJ , et al. Annual summary of vital statistics: 2006. Pediatrics 2008; 121: 788-801
- 18 Dong Y, Yu JL. An overview of morbidity, mortality and long-term outcome of late preterm birth. World J Pediatr 2011; 7: 199-204
- 19 Engle WA, Kominiarek MA. Late preterm infants, early term infants, and timing of elective deliveries. Clin Perinatol 2008; 35: 325-341 , vi
- 20 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
- 21 Leone A, Ersfeld P, Adams M, Schiffer PM, Bucher HU, Arlettaz R. Neonatal morbidity in singleton late preterm infants compared with full-term infants. Acta Paediatr 2012; 101: e6-e10
- 22 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
- 23 McIntire DD, Leveno KJ. Neonatal mortality and morbidity rates in late preterm births compared with births at term. Obstet Gynecol 2008; 111: 35-41
- 24 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
- 25 Reddy UM, Bettegowda VR, Dias T, Yamada-Kushnir T, Ko CW, Willinger M. Term pregnancy: a period of heterogeneous risk for infant mortality. Obstet Gynecol 2011; 117: 1279-1287
- 26 Canadian Institute for Health Information. Giving Birth in Canada. Ottawa, ON: CIHI; 2006
- 27 Gouyon JB, Iacobelli S, Ferdynus C, Bonsante F. Neonatal problems of late and moderate preterm infants. Semin Fetal Neonatal Med 2012; 17: 146-152
- 28 Raju TNK. Developmental physiology of late and moderate prematurity. Semin Fetal Neonatal Med 2012; 17: 126-131
- 29 Whyte RK. Neonatal management and safe discharge of late and moderate preterm infants. Semin Fetal Neonatal Med 2012; 17: 153-158
- 30 Bird TM, Bronstein JM, Hall RW, Lowery CL, Nugent R, Mays GP. Late preterm infants: birth outcomes and health care utilization in the first year. Pediatrics 2010; 126: e311-e319
- 31 Wetta L, Tita ATN. Early term births: considerations in management. Obstet Gynecol Clin North Am 2012; 39: 89-97