Increased neonatal morbidity despite pulmonary maturity for deliveries occurring before 39 weeks
Objective: To compare neonatal outcomes following deliveries <39 weeks after confirmation of fetal lung maturity with scheduled deliveries ≥39 weeks. Methods: A retrospective cohort study examining neonatal outcomes of women who were delivered following documented fetal pulmonary maturity at 36, 37, and 38 weeks compared to women undergoing a scheduled delivery at 39, 40, and 41 weeks. The χ(2)-test and Student's t-test were used to compare categorical and continuous data, respectively. Results: Delivery prior to 39 weeks following fetal pulmonary maturity was associated with a 8.4% composite neonatal morbidity rate as compared to 3.3% for deliveries at 39 weeks or greater (relative risk [RR] 2.9; confidence interval [CI] 2.4-3.6). Neonatal respiratory morbidity was significantly higher (5.4%) for those delivering at less than 39 weeks with documented fetal pulmonary maturity as compared to 2.1% for those delivering at 39 weeks or greater (RR 3.0; CI 2.3-3.9). Increased neonatal morbidity persisted for those delivered prior to 39 weeks even after excluding all diabetics (p < 0.001). Significant increases in neonatal morbidity were noted for deliveries prior to 39 weeks regardless of the mode of delivery. Conclusion: Despite fetal pulmonary maturity, delivery before 39 weeks is associated with significantly increased neonatal morbidity when compared to scheduled deliveries at 39 weeks or greater.
Available from: Stephanie J Ventura
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ABSTRACT: This report presents 2009 data on U.S. births according to a wide variety of characteristics. Data are presented for maternal characteristics including age, live-birth order, race and Hispanic origin, marital status, hypertension during pregnancy, attendant at birth, method of delivery, and infant characteristics (period of gestation, birthweight, and plurality). Birth and fertility rates by age, live-birth order, race and Hispanic origin, and marital status also are presented. Selected data by mother's state of residence are shown, as well as birth rates by age and race of father. Trends in fertility patterns and maternal and infant characteristics are described and interpreted.
Descriptive tabulations of data reported on the birth certificates of the 4.13 million births that occurred in 2009 are presented. Denominators for population-based rates are postcensal estimates derived from the U.S. 2000 census.
The number of births declined to 4,130,665 in 2009, 3 percent less than in 2008. The general fertility rate declined 3 percent to 66.7 per 1,000 women aged 15-44 years. The teenage birth rate fell 6 percent to 39.1 per 1,000. Birth rates for women in each 5-year age group from 20 through 39 years declined, but the rate for women 40-44 years continued to rise. The total fertility rate (estimated number of births over a woman's lifetime) was down 4 percent to 2,007.0 per 1,000 women. The number and rate of births to unmarried women declined, whereas the percentage of nonmarital births increased slightly to 41.0. The cesarean delivery rate rose again, to 32.9 percent. The preterm birth rate declined to 12.18 percent; the low birthweight rate was stable at 8.16 percent. The twin birth rate increased to 33.2 per 1,000; the triplet and higher-order multiple birth rate rose 4 percent to 153.5 per 100,000.
National vital statistics reports: from the Centers for Disease Control and Prevention, National Center for Health Statistics, National Vital Statistics System 11/2011; 60(1):1-70.
Available from: Xavier Demestre Guasch
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ABSTRACT: In the last decades has increased significantly The birth of children from 37 to 38 weeks of gestation, a period called early term, has significantly increased in the past twenty years or so, parallel to the increase in induced deliveries and the cesarean rate.
Retrospective cohorts population study, which included those babies born between 37 and 41 weeks of gestation in the period 1992-2011 (n=35.539). This population was divided into two cohorts, early term newborn (RNTP) of 37-38 weeks (n=11,318), and full term newborn (RNTC), of 39-41 weeks of gestation (n=24,221). The rates of cesarean section, neonatal unit admission, respiratory morbidity, apnea and need for assisted ventilation, hyperbilirubinemia requiring phototherapy, hypoglycemia, seizures, hypoxic-ischemia encephalopathy, need for parenteral nutrition and early sepsis were all reviewed.
There was a progressive increase in the number of caesarean sections throughout the period studied (from 30.9% to 40.3%). The cesarean section rate was higher in RNTP than in the RNTC (38.3% vs 31.3%, P<.0001). On comparing the two groups, significant differences were found in the rate of admission to neonatal unit, 9.1% vs 3.5% (P<.0001); respiratory morbidity (hyaline membrane 0.14% vs 0.007% [P<.0001], transient tachypnea 1.71% vs 0.45% [P<.0001], mechanical ventilation 0.2% vs 0.07% [P<.009], continuous positive airway pressure 0.11% vs 0.01% [P<.0001]), phototherapy 0.29% vs 0.07% (P<.0001), hypoglycemia 0.54% vs 0.11% (P<.0001), parenteral nutrition 0.16% vs 0.04% (P<.0001). There were no significant differences in the rate of early sepsis, pneumothorax, aspiration syndromes, seizures and hypoxic-ischemic encephalopathy.
In our environment, there is a significant number of RNTP, which have a significantly higher morbidity than newborns RNTC registered. After individualizing each case, it is essential not end a pregnancy before 39 weeks of gestation, except for maternal, placental or fetal conditions indicating that continuing the pregnancy may increase the risk for the fetus and/or the mother.
Anales de Pediatría 11/2013; 81(1). DOI:10.1016/j.anpedi.2013.10.015 · 0.83 Impact Factor
Available from: Jeroen Vanderhoeven
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To compare outcomes among late-preterm or early-term neonates according to fetal lung maturity status.
We conducted a retrospective cohort study of 234 eligible singletons delivered after fetal lung maturity (FLM) testing prior to 39 weeks gestation at our center over a two year time period. A primary composite neonatal outcome included death and major morbidities.
The overall rate of primary composite morbidity was 25/46 (52.2%) and 61/188 (32.4%) in the immature/transitional and mature groups, respectively. After adjustment for confounders including gestational age, the composite outcome was not significantly different; aOR 1.4 (CI 0.7-3.0). The rate of respiratory distress syndrome was significantly higher in the immature/transitional group; OR 3.4 (CI 1.1-10.3) as expected.
FLM status did not correlate with the spectrum of neonatal morbidities in late preterm and early term births. Neonatal complications remained common in both groups.
Journal of perinatology: official journal of the California Perinatal Association 01/2014; 34(4). DOI:10.1038/jp.2013.173 · 2.07 Impact Factor
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