Neonatal and 5-Year Outcomes After Birth at 30–34 Weeks of Gestation
Université de Rouen, Mont-Saint-Aignan, Haute-Normandie, France Obstetrics and Gynecology
(Impact Factor: 5.18).
08/2007; 110(1):72-80. DOI: 10.1097/01.AOG.0000267498.95402.bd
To evaluate the rates of in-hospital death, neonatal complications, and 5-year outcomes of infants born at 30-34 weeks of gestation.
In nine regions of France, all 2,020 stillbirths and live births at 30, 31, and 32 weeks in 1997 and all 457 births at 33 and 34 weeks in April and October 1997 were recorded. Survivors were evaluated at 5 years of age.
Increasing gestational age from 30 to 34 weeks was associated with progressive decreases in in-hospital mortality (from 8.1% to 0.4%) and neonatal complications (respiratory distress syndrome, 43.8% to 2.6%; maternofetal infections, 7.2% to 2.6%; and severe white matter injury, 5.5% to 1.3%). Although infants at 33 and 34 weeks of gestation rarely experienced necrotizing enterocolitis, bronchopulmonary dysplasia, or nosocomial infections, they still required endotracheal ventilation, antibiotics, or parenteral nutrition. At 5 years of age, older gestational age was associated with significant decreases in rates of cerebral palsy (6.3% at 30 weeks and 0.7% at 34 weeks) and mild to severe cognitive impairments (35.3% at 30 weeks and 23.9% at 34 weeks). In singletons, preterm rupture of membranes or preterm labor carried an increased risk of cerebral palsy but not of cognitive impairment.
Neonates born at 30-34 weeks experienced substantial morbidity and often required admission to neonatal intensive care units. These outcomes suggest that prolonging pregnancies beyond 34 weeks may be desirable whenever possible. Infants born at 30-34 weeks should be carefully monitored to ensure prompt detection and management of neurodevelopmental impairment.
Available from: Philippa Middleton
- "The latest Australian Cerebral Palsy Register Report (2009) shows that approximately 45% of all cases of cerebral palsy are associated with preterm birth . Whilst the highest risks are for extremely preterm infants , babies born between 30 and 33 completed weeks’ gestation still have significant risks  with the risk of cerebral palsy being up to eight times more likely than babies born at term . Moderate prematurity is responsible for as many cases of cerebral palsy as extreme prematurity . "
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ABSTRACT: BACKGROUND: Magnesium sulphate is currently recommended for neuroprotection of preterm infants for women at risk of preterm birth at less than 30 weeks' gestation, based on high quality evidence of benefit. However there remains uncertainty as to whether these benefits apply at higher gestational ages.The aim of this randomised controlled trial is to assess whether giving magnesium sulphate compared with placebo to women immediately prior to preterm birth between 30 and 34 weeks' gestation reduces the risk of death or cerebral palsy in their children at two years' corrected age.Methods/design DESIGN: Randomised, multicentre, placebo controlled trial.Inclusion criteria: Women, giving informed consent, at risk of preterm birth between 30 to 34 weeks' gestation, where birth is planned or definitely expected within 24 hours, with a singleton or twin pregnancy and no contraindications to the use of magnesium sulphate.Trial entry & randomisation: Eligible women will be randomly allocated to receive either magnesium sulphate or placebo.Treatment groups: Women in the magnesium sulphate group will be administered 50 ml of a 100 ml infusion bag containing 8 g magnesium sulphate heptahydrate [16 mmol magnesium ions]. Women in the placebo group will be administered 50 ml of a 100 ml infusion bag containing isotonic sodium chloride solution (0.9%). Both treatments will be administered through a dedicated IV infusion line over 30 minutes.Primary study outcome: Death or cerebral palsy measured in children at two years' corrected ageSample size: 1676 children are required to detect a decrease in the combined outcome of death or cerebral palsy, from 9.6% with placebo to 5.4% with magnesium sulphate (two-sided alpha 0.05, 80% power, 5% loss to follow up, design effect 1.2). DISCUSSION: Given the magnitude of the protective effect in the systematic review, the ongoing uncertainty about benefits at later gestational ages, the serious health and cost consequences of cerebral palsy for the child, family and society, a trial of magnesium sulphate for women at risk of preterm birth between 30 to 34 weeks' gestation is both important and relevant for clinical practice globally.Trial registration: Australian New Zealand Clinical Trials Registry - ACTRN12611000491965.
Available from: Marilyn Ballantyne
- "Organ systems are insufficiently developed to fully support extra-uterine life resulting in increased biological risk for complications of prematurity [2,3]. Compared to children born at term, preterm infants are at greater risk for neurodevelopmental disabilities including cerebral palsy , mental retardation [4,5], vision impairments [6,7], and hearing loss [4,8]. As preterm infants develop, there is an increased risk of cognitive and language delays [7,9,10], hyperkinetic disorders [4,11], behavioral and emotional problems [3,4], and learning disabilities [12-14]. "
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ABSTRACT: Preterm infants are at greater risk for neurodevelopmental disabilities than full term infants. Interventions supporting parents to improve the quality of the infant's environment should improve developmental outcomes for preterm infants. Many interventions that involve parents do not measure parental change, nor is it clear which intervention components are associated with improved parental outcomes. The aim of this review was to categorize the key components of early intervention programs and determine the direct effects of components on parents, as well as their preterm infants.
MEDLINE, EMBASE, CINAHL, ERIC, and Cochrane Database of Systematic Reviews were searched between 1990 and December 2011. Eligible randomized controlled trials (RCTs) included an early intervention for preterm infants, involved parents, and had a community component. Of 2465 titles and abstracts identified, 254 full text articles were screened, and 18 met inclusion criteria. Eleven of these studies reported maternal outcomes of stress, anxiety, depressive symptoms, self-efficacy, and sensitivity/responsiveness in interactions with the infant. Meta-analyses using a random effects model were conducted with these 11 studies.
Interventions employed multiple components categorized as (a) psychosocial support, (b) parent education, and/or (c) therapeutic developmental interventions targeting the infant. All interventions used some form of parenting education. The reporting quality of most trials was adequate, and the risk of bias was low based on the Cochrane Collaboration tool. Meta-analyses demonstrated limited effects of interventions on maternal stress (Z = 0.40, p = 0.69) and sensitivity/responsiveness (Z = 1.84, p = 0.07). There were positive pooled effects of interventions on maternal anxiety (Z = 2.54, p = 0.01), depressive symptoms (Z = 4.04, p <.0001), and self-efficacy (Z = 2.05, p = 0.04).
Positive and clinically meaningful effects of early interventions were seen in some psychosocial aspects of mothers of preterm infants. This review was limited by the heterogeneity of outcome measures and inadequate reporting of statistics. IMPLICATIONS OF KEY FINDINGS: Interventions for preterm infants and their mothers should consider including psychosocial support for mothers. If the intervention involves mothers, outcomes for both mothers and preterm infants should be measured to better understand the mechanisms for change.
Available from: Marjanneke de Jong
- "Belangrijk is ook dat niet alle matig te vroeg geboren kinderen ontwikkelingsproblemen vertonen. De bevinding dat een hoger percentage van deze kinderen een IQ-score onder de 85 heeft, vergeleken met op tijd geboren kinderen, terwijl de gemiddelde scores op gestandaardiseerde intelligentietests overeenkomen (Marret et al., 2007; Talge et al., 2010), geeft aan dat binnen de matig te vroeg geboren groep belangrijke verschillen optreden. Zelfs binnen de matig te vroeg geboren groep kan zwangerschapsduur van belang zijn. "
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ABSTRACT: In 2008 werden er in Nederland ruim 13.000 kinderen te vroeg geboren (7,7% van alle geboortes), waarvan 81 procent matig te vroeg werd geboren na een zwangerschapsduur tussen 32 en 36 weken (Stichting Perinatale Registratie Nederland, 2011 ). De afgelopen twee decennia is het aantal matige vroeggeboortes met 30 procent toegenomen (Martin et al., 2010 ). Hoewel de mortaliteitcijfers veel lager zijn bij deze kinderen dan bij ernstig te vroeg geboren kinderen (< 32 weken zwangerschapsduur), zijn de cijfers bijna tien keer hoger dan bij op tijd geboren kinderen (Mathews & MacDorman, 2008 ). Wat betreft neonatale complicaties hebben matig te vroeg geboren kinderen minder problemen dan ernstig te vroeg geboren kinderen, maar in vergelijking met op tijd geboren kinderen hebben ze een verhoogd risico op ademhalingsen voedingsmoeilijkheden, hypoglykemie en hyperbilirubine (Shapiro-Mendoza et al., 2008 ). Daarnaast zijn de hersenen van matig te vroeg geboren kinderen nog onvolgroeid: bij een zwangerschapsduur van 34 weken wegen de hersenen slechts 65 procent van het gewicht dat ze bij 40 weken zwangerschap hebben (Kinney, 2006 ). Ondanks de hoge prevalentie en de neonatale complicaties van matige vroeggeboorte is weinig bekend over de ontwikkelingsuitkomsten van deze kinderen op de lange termijn. In deze overzichtsstudie worden resultaten uit 28 studies over schooluitkomsten (zeven studies), cognitief functioneren (19 studies), gedragsproblemen (zes studies) en psychiatrische stoornissen (zes studies) bij matig te vroeg geboren kinderen gepresenteerd.
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