Prematuros tardíos: estudio clínico retrospectivo de sus causas y consecuencias

Abstract

RESUMENAntecedentes: Los niños nacidos entre las 34 0/7 y 36 6/7 semanas se denominan prematuros tardíos (PT), constituyen 5-7% de los nacidos y poseen mayor morbimortalidad que los niños de término. Objetivo: Analizar las causas de partos PT en nuestra institución. Comparar morbilidad neonatal de nacidos PT y de término. Métodos: Estudio de cohorte retrospectivo. Se revisan registros de nacimientos entre enero de 2009 y diciembre de 2012 identificando los nacidos vivos entre las 34 0/7 y 36 6/7 y entre las 39 0/6 y 40 6/7 semanas. Se identifica grupo clínico de parto prematuro al que pertenecen. Se compara frecuencia de resultados perinatales de nacidos PT y de término completo. Resultados: En el período estudiado nacieron 8.890 niños vivos. Tasa de partos PT fue 7,49% (n = 666). El 64,11% fue por causa idiopática o asociado a rotura de membranas y 35,89% por indicación médica. Dentro del grupo de indicaciones médicas un 19,25% de interrupciones no están basadas en evidencia y ninguna puramente electiva. Los PT, comparados con niños de término, tienen más riesgo de hospitalización y morbilidad neonatal; este riesgo es mayor a menor edad gestacional. Conclusiones: En nuestro hospital 1 de cada 5 PT pudo haber nacido a una edad gestacional mayor, lo que podría haber evitado los riesgos perinatales asociados. Se sugiere que las instituciones de salud analicen las causas de interrupciones del embarazo en el grupo de PT, lo que podría ser un indicador de calidad obstétrica. PALABRAS CLAVE: Prematuros tardíos, morbilidad, prematurez iatrogénica, epidemiología SUMMARYBackground: Children born between 34 0/7 and 36 6/7 weeks of gestation are called late-preterm infants. Represent 5 to 7% of live births and they are at higher risk of morbidity and mortality than term infants. Objective: To analyze causes of late preterm births in our institution. To compare neonatal morbidity in late-preterm and term infants. Methods: A retrospective cohort study. Birth records between January 2009 and December 2012 were reviewed identifying live births between 34 0/7 and 36 6/7 and between 39 0/6 and 40 6/7 weeks of gestation. Clinical group of preterm labor to which they belong was identified. Frequency of perinatal outcomes of late-preterm and term infants were compared. Results: In the period under study there were 8890 live birth. The late-preterm birth rate was 7.49% (n = 666); 64.11% of them was idiopathic in cause or associated with rupture of membranes and 35.89% was for medical indication. In the group of medical indications 19.25% of the interruptions were not based on evidence and none were purely elective. Late-preterm infants have higher risk of hospitalization and neonatal morbidity than term infants; this risk is higher at earlier gestational ages. Conclusions: In our hospital 1 in 5 late-preterm birth could have been born at higher gestational age, preventing perinatal risks. It is suggested that health institutions analyze causes of interruption of pregnancy in the late-preterm group, which could constitute an indicato...

Germinal Matrix-Intraventricular Hemorrhage of the Preterm Newborn and Preclinical Models: Inflammatory Considerations

“…Premature deliveries might be spontaneous deliveries (unexplained preterm labor or spontaneous rupture of the amniotic membranes) or deliveries caused by medical reasons [2,11]. Nevertheless, it has been reported that up to 20% of induced preterm births are based on clinical experience without a specifically justified medical indication, and whereas some studies have reported that purely elective preterm births might be under 10%, other studies have reported over 50% of non spontaneous late preterm births were non-evidence based [12][13][14]. Moreover, one in five cases could have reached a higher gestational age with fewer future complications [12].…”

“…Nevertheless, it has been reported that up to 20% of induced preterm births are based on clinical experience without a specifically justified medical indication, and whereas some studies have reported that purely elective preterm births might be under 10%, other studies have reported over 50% of non spontaneous late preterm births were non-evidence based [12][13][14]. Moreover, one in five cases could have reached a higher gestational age with fewer future complications [12]. In France and the USA, nearly 42% of all cesarean sections are performed when the fetus is growing poorly, increasing the birth rate and survival of the PTNB.…”