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Updated: Aug 23, 2026
Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Clinical outcomes of near-term infants
Marvin L Wang1, David J Dorer, Michael P Fleming
1Neonatology Unit, Pediatric Service, MassGeneral Hospital for Children, Founders 442, Fruit St, Boston, MA 02114, USA. mwang1@partners.org
Insights
Near-term infants experience more medical issues and higher hospital costs than full-term infants. These findings highlight near-term infants as a potentially overlooked at-risk group needing further attention.
Area of Science:
- Neonatal Medicine
- Pediatrics
- Healthcare Economics
Background:
- Near-term infants (born between 34 and 36 weeks gestation) may face unique health challenges.
- Understanding the medical and economic implications for near-term infants is crucial for optimizing neonatal care.
Purpose of the Study:
- To compare the incidence of medical problems in near-term infants versus full-term infants.
- To assess differences in hospital stay duration and associated costs between these two groups.
Main Methods:
- Analysis of electronic medical records for 7474 neonates, with subset analysis of 90 near-term and 95 full-term infants.
- Evaluation of clinical diagnoses, Apgar scores, length of stay, intravenous treatment, discharge delays, and hospital costs.
Main Results:
- Near-term infants showed significantly higher rates of temperature instability, hypoglycemia, respiratory distress, and jaundice.
- Near-term infants were more frequently evaluated for sepsis and received intravenous infusions.
- Hospital costs were significantly higher for near-term infants, with mean cost increases of $2630.
Conclusions:
- Near-term infants exhibit a greater burden of medical problems and increased healthcare expenditures compared to full-term infants.
- This study identifies near-term infants as a potentially unrecognized at-risk neonatal population requiring focused clinical attention.
Objective:
To test the hypothesis that near-term infants have more medical problems after birth than full-term infants and that hospital stays might be prolonged and costs increased.
Methods:
Electronic medical record database sorting was conducted of 7474 neonatal records and subset analyses of near-term (n = 120) and full-term (n = 125) neonatal records. Cost information was accessed. Length of hospital stay, Apgar scores, clinical diagnoses (temperature instability, jaundice, hypoglycemia, suspicion of sepsis, apnea and bradycardia, respiratory distress), treatment with an intravenous infusion, delay in discharge to home, and hospital costs were assessed.
Results:
Data from 90 near-term and 95 full-term infants were analyzed. Median length of stay was similar for near-term and full-term infants, but wide variations in hospital stay were documented for near-term infants after both vaginal and cesarean deliveries. Near-term and full-term infants had comparable 1- and 5-minute Apgar scores. Nearly all clinical outcomes analyzed differed significantly between near-term and full-term neonates: temperature instability, hypoglycemia, respiratory distress, and jaundice. Near-term infants were evaluated for possible sepsis more frequently than full-term infants (36.7% vs 12.6%; odds ratio: 3.97) and more often received intravenous infusions. Cost analysis revealed a relative increase in total costs for near-term infants of 2.93 (mean) and 1.39 (median), resulting in a cost difference of 2630 dollars (mean) and 429 dollars (median) per near-term infant.
Conclusions:
Near-term infants had significantly more medical problems and increased hospital costs compared with contemporaneous full-term infants. Near-term infants may represent an unrecognized at-risk neonatal population.
