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. 2015 Nov;100(6):F479-85.
doi: 10.1136/archdischild-2014-307347. Epub 2015 Apr 1.

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

Elaine M Boyle  1 , Samantha Johnson  1 , Bradley Manktelow  1 , Sarah E Seaton  1 , Elizabeth S Draper  1 , Lucy K Smith  1 , Jon Dorling  2 , Neil Marlow  3 , Stavros Petrou  4 , David J Field  1
Affiliations

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

Elaine M Boyle et al. Arch Dis Child Fetal Neonatal Ed. 2015 Nov.

Abstract

Objective: To 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/setting: Prospective 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.

Participants: All LMPT infants were eligible. A random sample of term-born infants (≥37 weeks) acted as controls.

Outcome measures: Neonatal unit (NNU) admission, respiratory and nutritional support, neonatal morbidities, investigations, length of stay and postnatal ward care were measured. Differences between centres were explored.

Results: 1146 (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.

Conclusions: LMPT 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.

Keywords: late preterm; moderately preterm; neonatal outcomes; prematurity.

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Figures

Figure 1
Figure 1
Flowchart to show recruitment to the Late and Moderately Preterm Birth Study (LAMBS).
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