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Late preterm infants - impact of perinatal factors on neonatal results. A clinical study
Grzegorz Jakiel1, Maria Wilińska2, Małgorzata Bińkowska1
1I Department of Obstetrics and Gynecology, Medical Centre of Postgraduate Education, Warsaw, Poland.
Insights
Late preterm infants (34-36 weeks) face significant health risks like respiratory failure and sepsis. Delivery method and antenatal care impact infant outcomes, highlighting the need for careful management.
Area of Science:
- Neonatal Medicine
- Perinatology
- Public Health
Background:
- Late preterm infants (34-36 weeks gestation) constitute 75% of preterm births.
- Despite appearing minimally immature, these infants are susceptible to serious health complications.
Purpose of the Study:
- To analyze perinatal factors influencing respiratory failure, metabolic issues, and early-onset sepsis (EOS) in late preterm infants.
- To identify risk factors associated with adverse outcomes in this population.
Main Methods:
- Retrospective analysis of maternal and infant data for late preterm births (34+0 - 36+6 weeks) at a tertiary academic center (2010-2011).
- Inclusion of pregnancy course, delivery type, interventions, and infant clinical status.
- Data collection by trained personnel with independent reliability monitoring.
Main Results:
- Confirmed significant links between infant immaturity, poor Apgar scores, and sepsis.
- Sepsis was more frequent with vaginal delivery and often co-occurred with respiratory distress syndrome (RDS).
- Maternal conditions, antibiotic prophylaxis, and delivery complications did not affect infection rates; perinatal asphyxia correlated with Cesarean section and RDS.
Conclusions:
- Establishing the delivery mode for late preterm infants is crucial for preventing neonatal infections.
- Improved intrauterine hypoxia diagnosis could decrease Cesarean section rates.
- Antenatal steroid therapy reduces the risk of RDS in late preterm infants, emphasizing the need for individualized delivery decisions based on maternal health.
Introduction:
Infants born between the 34(th) - 36(th) week of pregnancy account for 75% of all preterm infants. Their seemingly slight immaturity is related to serious health problems.
Objective:
The aim of the study was to analyse perinatal factors that influence the occurrence in infants of such problems as respiratory failure, metabolic problems and early onset sepsis (EOS).
Materials And Method:
The material for the study included all mothers and their late preterm infants: 34+0 - 36+6 born in our hospital (a tertiary referral academic centre) in 2010 and 2011. The course of pregnancy and delivery, the type of delivery, applied preventive measures and treatment, as well as demographic data and the clinical state of infants were all analysed. Data from individual documentation of each mother and infant were collected by 5 designated people and data reliability was independently monitored by a random control of the documentation conducted by the supervising person.
Results:
A statistically significant relationship between the occurrence of respiratory distress syndrome and infant immaturity, bad state after birth and sepsis in infants were confirmed. Sepsis was more common in the case of vaginal delivery, and coexisted with respiratory distress syndrome. The mother's diseases during pregnancy, a perinatal preventive antibiotic therapy, and possible delivery complications did not influence the infection. Perinatal asphyxia in an infant positively correlated with a Caesarean section and respiratory distress syndrome after birth.
Conclusions:
It is necessary to thoroughly establish the type of delivery of a late preterm infant in order to prevent an infection in the newborn child. The improvement of diagnosis of intrauterine hypoxia may reduce the number of Caesarean sections. The decision about late preterm delivery should be based on indices of the mother's state of health. Premature delivery is related to the occurrence of respiratory distress syndrome in a late preterm infant, although the risk is reduced by the application of an antenatal steroid therapy.
