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Indian Pediatr 2012;49: 929-930 |
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Early term – Continuing Conundrum of
Immaturity
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Suman Rao PN and Swarnarekha Bhat
Department of Neonatology, St. John’s Medical College
Hospital, Bangalore 560 034, India.
Email: [email protected]
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In the past decade, the focus in
newborn care has been on the concept of "late preterm". The
short term and long term complications of preterm birth
between 340/7
and 366/7 weekly
have become well recognized. Most doctors and patients
assume that once "term" gestation is reached; the outcome is
uniformly optimal [1]. However recent reports have
highlighted the differential outcomes even in term infants
born before 39 weeks and after. Respiratory distress, need
for ventilation, hypoglycemia, sepsis, and NICU admissions,
are higher in the infants born between 370/7
and 386/7 as
compared to after 39 weeks [2-3]. Tita, et al. [4]
determined the risk of adverse outcomes such as mechanical
ventilation, newborn sepsis, hypoglycemia, admission to the
neonatal ICU, and hospitalization for 5 days or more to be
increased by a factor of 1.8 to 4.2 for births at 37 weeks
and 1.3 to 2.1 for births at 38 weeks compared to 39 weeks.
Long term neurodevelopmental outcomes and need for special
education has also been found to be higher [5]. We reviewed
our 2011 annual data (Table I) and compared
the outcomes in 3 groups: late preterm (340/7
to 366/7 weeks),
37 weeks and 39 weeks. A delay of 2 weeks after 37 weeks
added 300 g to the weight and significantly reduced NICU
admissions, hypoglycemia and jaundice requiring
phototherapy.
TABLE I Neonatal Outcomes by Gestational Age
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34-36wk |
37wk |
39wk |
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(n=287) |
(n=329) |
(n=633) |
Mean birthweight (g)$ |
2279 |
2769 |
3024 |
LSCS (%) |
48.8 |
33.4 |
26.7 |
NICU admission (n)%* |
46.3 (133) |
18.2 (60) |
12.9 (82) |
Hypoglycemia (n)%# |
11.5 (33) |
4.5 (15) |
1.7 (11) |
Need for phototherapy (n)%* |
44.6 (128) |
25.8 (85) |
19.7 (125) |
Respiratory distress (n)%* |
13.4(38) |
3.6 (12) |
3.6 (23) |
* Comparison
between morbidities at gestational age 37 weeks and
39 weeks; *P<0.05; #P<0.05; $P<0.005. |
This heterogeneity in outcomes in the
group of "term" births has generated 2 categories: "early
term" births (37 0/7
and 386/7 weeks)
and "full term" births ( 390/7
to 41
6/7
weeks). This new definition of "early term"
emphasizes the continuing immaturity and potential for
adverse outcomes. Though spontaneous onset of labor before
"full term" or indicated delivery due to maternalfetal
complications are inevitable, the growing menace of
delivering high risk mothers early – as soon as term
gestation is reached – needs to be limited. As recommended,
induction or scheduled cesarean section without any
obstetric reason should be after 39 weeks. This has even
become accepted as a quality indicator of obstetric care.
References
1. Reddy UM, Bettegowda VR, Dias T,
Yamada-Kushnir T, Ko C, Willinger M. Term pregnancy: A
period of heterogeneous risk. Obstet Gynecol. 2011;117:
1279-87.
2. Balit JL, Greory KD, Reddy UM,
Gonzalez-Quintero VH, Hibbard JU, Ramirez MM, et al.
Maternal and neonatal outcomes by labor onset type and
gestational age. Am J Obstet Gynecol. 2010;202:245.e1-12.
3. Wilmink FA, Hukkelhoven CW, Lunshof S,
Mol BW, van der Post JA, Papatsonis DN. Neonatal outcome
following elective cesarean section beyond 37 weeks of
gestation: a 7-year retrospective analysis of a national
registry. Am J Obstet Gynecol. 2010;202:250,e1–8.
4. Tita A, Landon MB, Spong CY, Lai Y,
Leveno KJ, Varner MW, et al. Timing of elective
repeat cesarean delivery at term and neonatal outcomes. N
Engl J Med. 2009;360:111-20.
5. Mackay DF, Smith GC, Dobbie R, Pell JP. Gestational
age at delivery and special educational need: retrospective
cohort study of 407,503 school children. PLoS Med. 2010; 7:
e1000289.
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