Respiratory Morbidity in Late Preterm Births

Abstract

Context-Late preterm births (LPTB, 34 0/7-36 6/7 weeks) account for a growing proportion of prematurity-associated short term morbidities, particularly respiratory, that require specialized care and prolonged neonatal hospital stays.Objective-To assess short-term respiratory morbidity in LPTB compared to term births in a contemporary cohort of deliveries in the United States.Design, Setting, and Participants-Retrospective collection of electronic data from 12 institutions (19 hospitals) across the United States on 233,844 deliveries between 2002 and 2008. Charts were abstracted for all neonates with respiratory compromise admitted to a neonatal intensive care unit (NICU) and LPTB were compared to term births in regard to resuscitation, respiratory support and respiratory diagnoses. A multivariate logistic regression analysis compared infants at each gestational week controlling for factors that influence respiratory outcomes.Corresponding Author: Judith U. Hibbard, MD, Address: University of Illinois at Chicago, 820 South Wood Street, department of Ob/ Gyn, M/C 808, Chicago, IL 60612, Phone Number: 312 996-7300, Fax Number: 312 996-4135, jhibbar@uic.edu. * The Consortium on Safe LaborAll authors contributed to the study concept and design, acquisition of data, analysis and interpretation of data, drafting of the manuscript, critical revision of the manuscript for important intellectual content, statistical analysis, administrative, technical, or material support, and study supervision.Disclosures: All authors are without potential conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject of this manuscript. Respiratory distress syndrome decreased from 10.5% (390/3700) at 34 weeks to 0.3% (140/41,764) at 38 weeks. Similarly, TTN decreased from 6.4% (n=236) to 0.4% (n=155), pneumonia from 1.5% (n=55) to 0.1% (n=62), and respiratory failure from 1.6% (n=61) Conclusions-In a contemporary cohort, late preterm birth, compared with term delivery, was associated with increased risk for respiratory distress syndrome and other respiratory morbidity. NIH Public Access

Efficacy of inhaled nitric oxide in neonates with hypoxic respiratory failure and pulmonary hypertension: the Japanese experience

“…Neonates, whether born preterm or early term, are at increased risk for respiratory morbidity, which can include HRF associated with PH [19]. Preterm birth may disrupt normal lung development, resulting in a deficit in pulmonary circulation, decreased surface area for gas exchange, increased vasoreactivity and hypoxic vasoconstriction, which lead to increased pulmonary vascular resistance [20,21].…”

Neurological maturation of late preterm infants at 34 wk assessed by amplitude integrated electroencephalogram

“…Late preterm infants have increased morbidities and require disproportionate healthcare resources compared with term infants (2,3). Short term morbidities encountered in late preterm infants include respiratory distress syndrome (RDS), retained lung fluid, sepsis evaluations, temperature instability, hyperbilirubinemia, hypoglycemia, apnea, and poor feeding (4)(5)(6)(7)(8)(9). These morbidities reflect incomplete maturation of multiple organ systems including the central nervous system (CNS) (10).…”

Respiratory Morbidity in Late-Preterm Births: A Prospective Observational Study at a Tertiary Care Hospital

“…Incidence of respiratory morbidity in our study in the late preterms was 35 %. In studies conducted by Judith et al, Jaiswal et al and Wagh et al [4][5][6], the incidence of respiratory morbidity in the late-preterm group was found to be 9, 10.5 and 29.8 %, respectively. Our study appears to show a higher incidence as we have included babies who had mild RDS lasting for few hours immediately after birth requiring no active intervention.…”

“…Various studies have shown that late-preterm infants have considerable short-and long-term morbidity and mortality; hence, every attempt must be made to prolong the pregnancy till 36 completed weeks [3,5,13]. Maternal and fetal indications for early delivery should be critically evaluated and risk benefit ratio should be judicially analyzed, keeping in mind the risks of neonatal morbidity.…”