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					SHORT-TERM NEONATAL OUTCOME IN LOW-RISK SPONTANEOUS
SINGLETON LATE PRETERM DELIVERIES
Melamed N. 1,4, Klinger G. 3,4, Tenenbaum-Gavish K. 1, Herscovici T. 3,
Linder N. 2,4, Hod M. 1,4, Yogev Y. 1,4
Helen Schneider Hospital for Women 1 and Nursery 2, Rabin Medical
Center,
Department of Neonatal Intensive Care 3, Schneider Children’s Medical
Center of Israel Petach Tikva, and Sackler Faculty of Medicine 4, Tel Aviv
University, Tel Aviv, Israel

Objective: Data regarding neonatal outcome of late preterm infants (340/7-
366/7) remain scarce. Our aim was to estimate the effect of gestational age
on short-term neonatal morbidity in cases of spontaneous, low-risk
singleton late preterm deliveries, and to identify predictors of adverse
neonatal outcome.
Methods: A retrospective study of all spontaneous, low-risk late preterm
deliveries during the years 1997-2006 (n=2,478). Multiple gestations and
pregnancies complicated by preterm premature rupture of membranes
(PPROM) or maternal or fetal complications were excluded. Short-term
neonatal outcome was compared with a control group of full-term
deliveries in a 3:1 ratio (n=7,434). Logistic regression analysis was used
to identify risk factors for neonatal morbidity among late preterm infants.
Results: Compared with full-term infants, spontaneous late preterm
delivery was independently associated with an increased risk of neonatal
morbidity, including respiratory distress syndrome (4.2% vs. 0.1%,
P<0.001), sepsis (0.4% vs. 0.04%,P<0.001), intraventricular hemorrhage
(0.2% vs. 0.02%,P<0.001), hypoglycemia (6.8% vs. 0.4%,P<0.001), and
jaundice requiring phototherapy (18% vs. 2.5%,P<0.001). Cesarean
delivery (OR=2.1, 95%-CI 1.6-2.6), male gender (OR=1.4, 95%-CI 1.1-
1.8) and multiparity (OR=2.2, 95%-CI 1.7-2.8) were independent risk
factors for neonatal respiratory morbidity in cases of late preterm
deliveries. The relationship between gestational age and neonatal
morbidity was of continuous nature with a nadir at about 39 weeks rather
than a term-preterm threshold phenomenon, and was unrelated to
birthweight.
Conclusion: Late prematurity is associated with significant neonatal
morbidity in cases of spontaneous low-risk singleton deliveries. This
information is important for appropriate counselling, and should stimulate
efforts to decrease the rate of late preterm deliveries.

				
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posted:10/3/2011
language:English
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