Impact of Late Preterm Birth on Neonatal Intensive Care Resources in a Tertiary Perinatal Center

Abstract

Objective To examine delivery indications, short-term morbidities, and use of resources for late preterm infants admitted to the neonatal intensive care unit (NICU) at a tertiary perinatal center.

Study Design Data for 1137 inborn infants 34⁰/₇ to 36⁶/₇ weeks' gestational age discharged between July 2004 and December 2009 were collected from an electronic NICU database. Birth information was obtained from maternal charts.

Results Forty-two percent of late preterm infants were admitted to the NICU. Their mean ( ±  standard deviation) birth weight was 2347 ± 569 g; 15.1% were small for gestational age, 35.5% were multiples, and 17.8% had an antenatally diagnosed anomaly. Most births (52%) occurred following spontaneous rupture of membranes or labor. Cesarean section rate was 56.8%. Mortality rate was 1.2%. Most frequent morbidities were transient tachypnea (18.8%), cardiac or other congenital anomaly (16.8%), and respiratory distress syndrome (7.4%). Although 41.5% received ventilatory support, duration was short (1.1 ± 3.1 days). Mean length of NICU stay was 8.1 ± 9.3 days with 38% transferred to community hospitals before discharge.

Conclusion For many late preterm infants admitted to the NICU, the duration of intensive therapy was short and some required no interventions. One impact of late preterm birth was bed occupancy.

Keywords

late preterm - preterm birth - health care utilization - neonatal morbidities

• References

• 1 Kramer MS, Demissie K, Yang H, Platt RW, Sauvé R, Liston R. Fetal and Infant Health Study Group of the Canadian Perinatal Surveillance System. The contribution of mild and moderate preterm birth to infant mortality. JAMA 2000; 284: 843-849
• 2 Public Health Agency of Canada. Canadian Perinatal Health Report, 2008 Edition. Ottawa, Canada: Public Health Agency of Canada; 2008
• 3 Martin JA, Kirmeyer S, Michelle Osterman M, Shepherd RA. Born a bit too early: recent trends in late preterm birth. National Centre for Health Statistics Data Brief 2009. Available at: http://www.cdc.gov/nchs/data/databriefs/db24.pdf . Accessed November 20, 2009
• 4 Loftin RW, Habli M, Snyder CC, Cormier CM, Lewis DF, Defranco EA. Late preterm birth. Rev Obstet Gynecol 2010; 3: 10-19
• 5 Lee SK. Fetus and Newborn Committee. Canadian Paediatric Society. Levels of neonatal care. Paediatr Child Health 2006; 11: 303-306
• 6 Shah P, Lee S, Yoon W, Chan P. , and Members of the Report Review Committee. Canadian Neonatal Network Annual Report 2010. . Available at: www.canadianneonatalnetwork.org . Accessed June 2010
• 7 Whyte RK. Fetus and Newborn Committee. Canadian Paediatric Society. Safe discharge of the late preterm infant. Paediatr Child Health 2010; 15: 655-660
• 8 Kramer MS, Platt RW, Wen SW , et al; Fetal/Infant Health Study Group of the Canadian Perinatal Surveillance System. A new and improved population-based Canadian reference for birth weight for gestational age. Pediatrics 2001; 108: E35
• 9 Shennan AT, Dunn MS, Ohlsson A, Lennox K, Hoskins EM. Abnormal pulmonary outcomes in premature infants: prediction from oxygen requirement in the neonatal period. Pediatrics 1988; 82: 527-532
• 10 Bell MJ, Ternberg JL, Feigin RD , et al. Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging. Ann Surg 1978; 187: 1-7
• 11 Kitsommart R, Janes M, Mahajan V , et al. Outcomes of late-preterm infants: a retrospective, single-center, Canadian study. Clin Pediatr (Phila) 2009; 48: 844-850
• 12 Vachharajani AJ, Dawson JG. Short-term outcomes of late preterms: an institutional experience. Clin Pediatr (Phila) 2009; 48: 383-388
• 13 Pulver LS, Denney JM, Silver RM, Young PC. Morbidity and discharge timing of late preterm newborns. Clin Pediatr (Phila) 2010; 49: 1061-1067
• 14 Melamed N, Klinger G, Tenenbaum-Gavish K , et al. Short-term neonatal outcome in low-risk, spontaneous, singleton, late preterm deliveries. Obstet Gynecol 2009; 114 (2 Pt 1) 253-260
• 15 Leone A, Ersfeld P, Adams M, Schiffer PM, Bucher HU, Arlettaz R. Neonatal morbidity in singleton late preterm infants compared with full-term infants. Acta Paediatr 2012; 101: e6-e10
• 16 Dimitriou G, Fouzas S, Georgakis V , et al. Determinants of morbidity in late preterm infants. Early Hum Dev 2010; 86: 587-591
• 17 Rocha CO, Bittar RE, Zugaib M. Neonatal outcomes of late-preterm birth associated or not with intrauterine growth restriction. Obstet Gynecol Int 2010; ;2010:231842. DOI: 10.1155/2010/231842.
• 18 Yudin MH, van Schalkwyk J, Van Eyk N , et al; Society of Obstetricians and Gynaecologists of Canada. Antibiotic therapy in preterm premature rupture of the membranes. J Obstet Gynaecol Can 2009; 31: 863-867 , 868–874
• 19 Spong CY, Mercer BM, D'alton M, Kilpatrick S, Blackwell S, Saade G. Timing of indicated late-preterm and early-term birth. Obstet Gynecol 2011; 118 (2 Pt 1) 323-333
• 20 Gelas T, Gorduza D, Devonec S , et al. Scheduled preterm delivery for gastroschisis improves postoperative outcome. Pediatr Surg Int 2008; 24: 1023-1029
• 21 Reddy UM, Ko C-W, Raju TNK, Willinger M. Delivery indications at late-preterm gestations and infant mortality rates in the United States. Pediatrics 2009; 124: 234-240
• 22 McIntire DD, Leveno KJ. Neonatal mortality and morbidity rates in late preterm births compared with births at term. Obstet Gynecol 2008; 111: 35-41
• 23 Holland MG, Refuerzo JS, Ramin SM, Saade GR, Blackwell SC. Late preterm birth: how often is it avoidable?. Am J Obstet Gynecol 2009; 201: 404 , e1–e4
• 24 Lubow JM, How HY, Habli M, Maxwell R, Sibai BM. Indications for delivery and short-term neonatal outcomes in late preterm as compared with term births. Am J Obstet Gynecol 2009; 200: e30-e33
• 25 Gouyon J-B, Vintejoux A, Sagot P, Burguet A, Quantin C, Ferdynus C. Burgundy Perinatal Network. Neonatal outcome associated with singleton birth at 34–41 weeks gestation. Int J Epidemiol 2010; 39: 769-776
• 26 McLaurin KK, Hall CB, Jackson EA, Owens OV, Mahadevia PJ. Persistence of morbidity and cost differences between late-preterm and term infants during the first year of life. Pediatrics 2009; 123: 653-659