Short-term Morbidities in Moderate and Late Preterm Infants

Abstract

Objective: To determine (1) the association between neonatal morbidity and gestational age and (2) the impact of pre-existing maternal medical conditions, pregnancy and birth complications on neonatal outcome in moderate and late preterm infants (32–36 completed weeks).

Methods: Retrospective single-centre cohort study including all moderate and late preterm infants without congenital anomalies born at the Children’s and Maternity Hospital Linz, Austria, between January 2007 and June 2010. Stepwise regression analysis was used to determine significant associations between morbidities, maternal and perinatal complications and the gestational age.

Results: Of 870 infants included the incidence of neonatal morbidities increased from 24% at 36 weeks to 43% at 35 weeks’, 55% at 34 weeks’, 75% at 33 weeks’ and 93% at 32 weeks’ gestation. Infants at 32 weeks had a 4-fold (RR: 3.88; 95% CI: 1.87–8.06) increased risk compared with those at 36 weeks, and infants of 32 weeks were 16 times (RR: 16.01; 95% CI: 9.82–26.09) more likely to be admitted to the NICU than infants of 36 weeks’. Hyperbilirubinemia (29%) and respiratory morbidity (14.3%) were the most common neonatal diagnoses. Intrauterine growth restriction, preeclampsia, preterm premature rupture of the membranes, lack of antenatal steroid administration, antepartum hemorrhage, multiple pregnancy and male gender were all associated with any kind of neonatal morbidity, admission rate to the NICU and length of hospital stay (p<0.05).

Conclusion: Nearly half of all infants suffered from any morbidity, and several risk factors were identified being significantly associated with NICU admission rate and length of hospitalization.

Zusammenfassung

Hintergrund: Ziel dieser Arbeit ist es, die Morbidität von moderaten und späten Frühgeborenen (32/0–36/6 Gestationswochen [GW]) während des Krankenhauserstaufenthalts, die mit der jeweiligen Gestationswoche einhergeht, sowie den Einfluss von mütterlichen und perinatalen Komplikationen darauf, zu untersuchen.

Methode: Retrospektive Kohortenstudie mit Frühgeborenen von 32/0 bis 36/6 GW ohne kongenitale Anomalien, geboren an der Landes-Frauen- und Kinderklinik Linz zwischen 2007 und Juni 2010. Eine logistische Regressionsanalyse wurde angewendet, um den Zusammenhang zwischen Morbidität, mütterlichen und perinatalen Komplikationen und dem Gestationsalter festzustellen.

Ergebnisse: 870 Frühgeborene wurden eingeschlossen. Die Inzidenz der neonatalen Morbidität stieg mit abnehmendem Gestationsalter von 24% nach 36, auf 43% nach 35, auf 55% nach 34, auf 75% nach 33 und auf 93% nach 32 GW. Am häu­figsten trat eine therapiebedürftige Hyperbilirubinämie (29%) auf, gefolgt von respirato­rischen Problemen (14%). Ein niedrigeres Gestationsalter war ein unabhängiger Risikofaktor für eine erhöhte Morbidität und einen längeren Aufenthalt im Krankenhaus bzw. auf der Intensivstation. Perinatale und mütterliche medizinische Komplikationen (Lungenreifungsinduktion, komplizierte Schwangerschaft, PPROM, Dystrophie, Mehrlingsgeburt, männliches Geschlecht) nahmen Einfluss auf das Risiko für einige Morbiditätsgruppen.

Schlussfolgerung: Frühgeborene zwischen 32/0 und 36/6 Gestationswochen haben ein hohes Risiko für neonatale Erkrankungen, wobei ein niedrigeres Gestationsalter bei Geburt das Morbiditätsrisiko unabhängig von anderen Faktoren erhöht.·

Key words

moderate preterm - late preterm - short-term morbidities - neonatal intensive care unit

Schlüsselwörter

späte Frühgeborene - mäßig Frühgeborene - neonatale Morbiditäten - neonatale Intensivstation

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