Early-term infants face higher neonatal morbidity risk

Infants born prematurely had an increased risk for higher neonatal morbidity and more neonatal ICU admissions compared with full-term infants, according to recent study findings published in JAMA Pediatrics.

Researchers examined medical records of 33,488 live births from 2006 to 2008, most of which had a gestational age of 37 to 41 weeks.

Twenty-seven percent of births were early term (born between 37 and 38 weeks gestation). Early-term participants had a higher risk for hypoglycemia compared with term participants (4.9% vs. 2.5%). Other increased risks included neonatal ICU admission (early term, 8.8%; full term, 5.3%); need for respiratory support (early term, 2%; full term, 1.1%); requirement of IV fluids (early term, 7.5%; full term, 4.4%).

Higher risks for neonatal ICU admission and morbidity were seen in early-term births delivered by cesarean section. Neonatal ICU admission was also more common among early-term births delivered vaginally compared with term newborns.

“We conclude that early-term delivery is associated with greater morbidity and with increased admission to the [neonatal ICU] or neonatology service in a geographic area-based setting,” the researchers wrote. “This increased risk is more profound with cesarean section deliveries but exists for vaginal deliveries as well.”

In an accompanying editorial, William Oh, MD, of Women and Infants’ Hospital in Providence, R.I., and Tonse N. K. Raju, MD, DCH, of Eunice Kennedy Shriver National Institute of Child Health and Human Development, wrote that the study identifies important areas for obstetric and neonatal research.

“The findings reinforce the concept that maturation is a continuum, and any preset gestational age cannot be assumed to provide a clear separation between immaturity and maturity,” they wrote. “Because all immature infants carry finite, measurable risks, the indications for deliveries even among term infants need to be justified. In the presence of maternal or fetal illnesses, the risks and benefits of immediate delivery compared with postponement need to be closely assessed.”

For more information:

Oh W. JAMA Pediatr. 2013;doi:10.1001/jamapediatrics.2013.2593.

Sengupta S. JAMA Pediatr. 2013;doi:10.1001/jamapediatrics.2013.2581.

Disclosure: The study was funded in part by the Division of Neonatology, University of Buffalo, an American Academy of Pediatrics Resident Research Grant and the Thomas F. Frawley, MD, Residency Research Fellowship Fund, University of Buffalo.