Journal Article

Neonatal outcomes and delivery of care for infants born late preterm or moderately preterm: a prospective population-based study

Seaton, Sarah E, Manktelow, Bradley, Draper, Elizabeth S, Petrou, Stavros, Boyle, Elaine M, Johnson, Samantha, Smith, Lucy K, Marlow, Neil, Field, David J, Dorling, Jon

2015

Overview

ObjectiveTo describe neonatal outcomes and explore variation in delivery of care for infants born late (34–36  weeks) and moderately (32–33 weeks) preterm (LMPT).Design/settingProspective population-based study comprising births in four major maternity centres, one midwifery-led unit and at home between September 2009 and December 2010. Data were obtained from maternal and neonatal records.ParticipantsAll LMPT infants were eligible. A random sample of term-born infants (≥37 weeks) acted as controls.Outcome measuresNeonatal unit (NNU) admission, respiratory and nutritional support, neonatal morbidities, investigations, length of stay and postnatal ward care were measured. Differences between centres were explored.Results1146 (83%) LMPT and 1258 (79% of eligible) term-born infants were recruited. LMPT infants were significantly more likely to receive resuscitation at birth (17.5% vs 7.4%), respiratory (11.8% vs 0.9%) and nutritional support (3.5% vs 0.3%) and were less likely to be fed breast milk (64.2% vs 72.2%) than term infants. For all interventions and morbidities, a gradient of increasing risk with decreasing gestation was evident. Although 60% of late preterm infants were never admitted to a NNU, 83% required medical input on postnatal wards. Clinical management differed significantly between services.ConclusionsLMPT infants place high demands on specialist neonatal services. A substantial amount of previously unreported specialist input is provided in postnatal wards, beyond normal newborn care. Appropriate expertise and planning of early care are essential if such infants are managed away from specialised neonatal settings. Further research is required to clarify optimal and cost-effective postnatal management for LMPT babies.

• Publisher: BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Biomedical research / Breast milk / Clinical medicine / Delivery of Health Care - methods / Delivery, Obstetric - methods / Female / Funding / Hospitals / Humans / Infant, Newborn / Infant, Premature / Infant, Premature, Diseases - therapy / Infants / Length of Stay / Male / Midwifery / Morbidity / Mothers / Original / Population / Population studies / Pregnancy / Premature birth / Prospective Studies / Studies / Ventilation