DOI: http://dx.doi.org/10.18203/2349-3291.ijcp20184284

Outcome of moderate preterm and term babies at tertiary care centre

Shaitan Singh Balai, Durgavati Katara, Vivek Arora

Abstract


Background: To study the maternal risk factors, morbidity, mortality of moderate preterm in comparison to term neonates.

Methods: This Cohort study involved two hundred fifty consecutively born moderate preterm and equal number of term newborns delivered in a tertiary care hospital. They were followed till discharge for morbidities and mortality. Detailed maternal and neonatal factors were studied and compared between the two groups.

Results: Moderate preterm babies constituted 55% of all live preterm births during the study period. The odds of babies developing major morbidity was significantly more in those whose mothers had hypertension and infections (OR 2.69 95% CI: 1.55, 4.68 and 2.08, 95% CI: 1.6, 2.71 respectively). In the study group, 42.4% and 20.8% babies suffered major and minor morbidity compared to 8.4% and 6.8% of term controls respectively. moderate preterm neonates had significantly higher odds of developing morbidity like respiratory distress (12.4% vs. 5.6%, OR 2.21, 95%CI 1.21,4.11), need for non-invasive(17.3% vs. 5.7%, OR 3.05 95% CI 1.69, 5.47) and invasive ventilation (14.6% vs. 1.7%, OR 8.62, 95% CI 3.09, 24.04), sepsis (20.8% vs. 5.2%, OR 5.20, 95% CI 2.71, 9.99), seizures (22.8% vs. 4.8%, OR 4.75 95%CI 2.61, 8.63), shock (17.6% vs. 4.4%, OR 4.00 95% CI 2.12,7.56), and jaundice (26% vs. 6%, OR 4.33 95%CI 2.54, 7.39). By logistic regression, the odds of developing major morbidity decreased with increasing gestational age (aOR 0.28 95% CI 0.18, 0.45; p<0.001) and increased with hypertensive disease of pregnancy (aOR 2.16 95% CI 1.09, 4.260; p00.026).

Conclusions: Moderate preterm neonates have significantly more mortality and morbidity compared to term controls. Maternal hypertension and lower gestational age are the strongest predictors of morbidity.


Keywords


Moderate preterm, Morbidity, Outcome

Full Text:

PDF

References


Raju TN, Higgins RD, Stark AR, Leveno KJ. Optimizing care and outcome for late-preterm (near-term) infants: a summary of the workshop sponsored by the National Institute of Child Health and Human Development. Pediatrics. 2006;118(3):1207-14.

Sibai BM. Preeclampsia as a cause of preterm and late preterm (near term) births. Semin Perinatol. 2006;30:16-9.

Dobak WJ, Gardner MO. Latepreterm gestation: Physiology oflabor and implications for delivery. Clin Perinatol. 2006;33:765-77.

Mally PV, Bailey S. Hendricks- Munoz KD. Clinical issues in the management of late preterm infants. Curr Probl Pediatr Adolesc Health Care. 2010;40:218-33.

Eichenwald EC. Neonatal mortality and morbidity in late preterm births. AAP Grand Rounds. 2008;19:61-2.

Khashu M, Narayanan M, Bhargava S, Osiovich H. Perinatal out- comes associated with preterm birth at 33 to 36 weeks’ gestation: a population based cohort study. Pediatrics. 2009;123:109-13.

Wang ML, Dorer DJ, Fleming MP, Catlin EA. Clinical outcomes of near-term infants. Pedaitrics. 2004;114:372-6.

Shapiro-Mendoza CK, Tomashek KM, Kotelchuck M. Effect of late-preterm birth and maternal medical conditions on newborn morbidity risk. Pediatrics. 2008;121:223-32.

Jaiswal A, Murki S, Gaddam P, Reddy A. Early neonatal morbidities in late preterm infants. Indian pediatrics. 2011;48(8):607.

Raju TNK. Epidemiology of late preterm (near term) births. Clin Perinatol. 2006;33:751-65.

Dimitrou G, Fousaz S, Georgakis V. Determinants of morbidity in late preterm infants. Early Hum Dev. 2010;86:587-91.

De Luca R, Boulvain M, Irion O, Berner M, Pfister RE. Incidence of early neonatal mortality and morbidity after late preterm and term cesarian delivery. Pediatrics. 2009;123:1064-71.

Ramachandrappa A, Jain L. Health issues of the late preterm infant. Pediatr Clin N Am. 2009;56:565-77.

Engle WA. Infants born late preterm: definition, physiologic and metabolic immaturity, and outcomes. Neo Rev. 2009;10:280-6.

Engle WA, Tomashek KM, Wallman C. The committee on fetus and newborn. “Late preterm” infants: a population at risk. Pediatrics. 2007;120:1390-401.

Ortigosa Rocha C, Bittar RE, Zugaib M. Neonatal outcomes of late-preterm birth associated or not with intrauterine growth restriction. Obstetr Gynecol Int. 2010;2010.

Young PC, Glasgow TS, Guest-Warnick G, Stoddard G. Mortality of late-preterm (Near-term) newborns in Utah. Pediatrics. 2007;119:e659-65.

Kominiarek MA. Infants born late preterm: Indications and recommendations for obstetric care. Neo Reviews. 2009;10:295-302.

Tomashek KM. Shapiro- Mendoza C, Weiss J. Early discharge among late preterm and term newborns and risk of neonatal morbidity. Semin Perinatol. 2006;30:61-8.

Mac Bird T, Bronstein JM, Hall RW, Lowery CL, Nugent R, Mays GP. Late pretem infants: birth outcomes and health care utilization in the first year. Pedaitrics. 2010;126:e311-9.