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Original Investigation |

Adverse Neonatal Outcomes Associated With Early-Term Birth

Shaon Sengupta, MD, MPH1; Vivien Carrion, MD2; James Shelton, MS3; Ralph J. Wynn, MD2; Rita M. Ryan, MD4; Kamal Singhal, MD5; Satyan Lakshminrusimha, MD2
[+] Author Affiliations
1Division of Neonatology, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
2Division of Neonatology, Department of Pediatrics, Women and Children’s Hospital of Buffalo, Buffalo, New York
3Department of Obstetrics and Gynecology, Women and Children’s Hospital of Buffalo, Buffalo, New York
4Division of Neonatology, Department of Pediatrics, Medical University of South Carolina, Charleston
5Department of Pediatrics, Sisters of Charity Hospital, Buffalo, New York
JAMA Pediatr. 2013;167(11):1053-1059. doi:10.1001/jamapediatrics.2013.2581.
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Importance  Full-term neonates born between 37 and 41 weeks’ gestational age have been considered a homogeneous, low-risk group. However, recent evidence from studies based on mode of delivery has pointed toward increased morbidity associated with early-term cesarean section births (37-38 weeks) compared with term neonates (39-41 weeks).

Objective  To compare the short-term morbidity of early-term vs term neonates in a county-based birth cohort using the primary objective of admission to a neonatal intensive care unit (NICU) or neonatology service.

Design, Setting, and Participants  Retrospective population-based 3-year birth cohort study (January 1, 2006–December 31, 2008) at all major birth hospitals in Erie County, New York. All full-term live births comprised the birth cohort; this information was obtained from the hospitals’ perinatal databases, and data pertaining to NICU or neonatology service admissions were extracted from individual medical records.

Exposure  Gestational age of early term (370/7-386/7 weeks) vs term (390/7-410/7 weeks).

Main Outcomes and Measures  Admission to the NICU or neonatology service.

Results  There were 33 488 live births during the 3-year period, of which 29 741 had a gestational age between 37 and 41 weeks. Of all live births, 9031 (27.0%) were early term. Compared with term infants, early-term neonates had significantly higher risks for the following: hypoglycemia (4.9% vs 2.5%; adjusted odds ratio [OR], 1.92), NICU or neonatology service admission (8.8% vs 5.3%; adjusted OR, 1.64), need for respiratory support (2.0% vs 1.1%; adjusted OR, 1.93), requirement for intravenous fluids (7.5% vs 4.4%; adjusted OR, 1.68), treatment with intravenous antibiotics (2.6% vs 1.6%; adjusted OR, 1.62), and mechanical ventilation or intubation (0.6% vs 0.1%; adjusted OR, 4.57). Delivery by cesarean section was common among early-term births (38.4%) and increased the risk for NICU or neonatology service admission (12.2%) and morbidity (7.5%) compared with term births. Among vaginal deliveries, early-term neonates (6.8%) had a significantly higher rate of NICU or neonatology service admission compared with term neonates (4.4%).

Conclusions and Relevance  Early-term births are associated with high neonatal morbidity and with NICU or neonatology service admission. Evaluation of local prevalence data will assist in implementation of specific preventive measures and plans, as well as prioritize limited health care resources.

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Figures

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Figure 1.
Cohort Population Flow

aIndicates the incidence of cesarean section (C-section) among all births at that gestational age. bIncludes all congenital anomalies that mandated admission to the neonatal intensive care unit (NICU). cIndicates the incidence of C-section among admissions to the NICU at that gestational age. Shaded boxes include the comparison groups of interest.

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Figure 2.
Admissions to the Neonatal Intensive Care Unit (NICU)

Bars denote the absolute number of neonates requiring admission to the NICU or neonatology service for each mode of delivery and at each gestational age. Lines denote the number of neonates requiring admission to the NICU or neonatology service per 1000 full-term live births by mode of delivery at each gestational age.

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Figure 3.
Respiratory Morbidity and the Need for Intubation

Bars denote the absolute number of neonates having respiratory morbidity for each mode of delivery and at each gestational age. Lines denote the number of neonates requiring intubation per 1000 full-term live births by mode of delivery at each gestational age.

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