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Observational Study
. 2014 Jun 3;40:52.
doi: 10.1186/1824-7288-40-52.

Short-term Respiratory Outcomes in Late Preterm Infants

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Free PMC article
Observational Study

Short-term Respiratory Outcomes in Late Preterm Infants

Miria Natile et al. Ital J Pediatr. .
Free PMC article

Abstract

Objective: To evaluate short-term respiratory outcomes in late preterm infants (LPI) compared with those of term infants (TI).

Methods: A retrospective study conducted in a single third level Italian centre (2005-2009) to analyse the incidence and risk factors of composite respiratory morbidity (CRM), the need for adjunctive therapies (surfactant therapy, inhaled nitric oxide, pleural drainage), the highest level of respiratory support (mechanical ventilation - MV, nasal continuous positive airway pressure--N-CPAP, nasal oxygen) and the duration of pressure support (hours in N-CPAP and/or MV).

Results: During the study period 14,515 infants were delivered. There were 856 (5.9%) LPI and 12,948 (89.2%) TI. CRM affected 105 LPI (12.4%), and 121 TI (0.9%), with an overall rate of 1.6%. Eighty-four LPI (9.8%) and 73 TI (0.56%) received respiratory support, of which 13 LPI (1.5%) and 16 TI (0.12%) were ventilated. The adjusted OR for developing CRM significantly increased from 3.3 (95% CI 2.0-5.5) at 37 weeks to 40.8 (95% CI 19.7-84.9%) at 34 weeks. The adjusted OR for the need of MV significantly increased from 3.4 (95% CI 1.2-10) at 37 weeks to 34.4 (95% CI 6.7-180.6%) at 34 weeks. Median duration of pressure support was significantly higher at 37 weeks (66.6 h vs 40.5 h). Twin pregnancies were related to a higher risk of CRM (OR 4.3, 95% CI 2.6-7.3), but not independent of gestational age (GA). Cesarean section (CS) was associated with higher risk of CRM independently of GA, but the OR was lower in CS with labour (2.2, 95% CI 1.4-3.4 vs 3.0, 95% CI 2.1-4.2).

Conclusions: In this single third level care study late preterm births, pulmonary diseases and supportive respiratory interventions were lower than previously documented. LPI are at a higher risk of developing pulmonary disease than TI. Infants born from elective cesarean sections, late preterm twins in particular and 37 weekers too might benefit from preventive intervention.

Figures

Figure 1
Figure 1
Start of respiratory support (hours since birth) among LPI and TI with CRM. Box plots indicate the mean value (dots) and the quartiles (horizontal segments). For abbreviations see text.
Figure 2
Figure 2
Duration of pressure support. Kaplan-Meier curve showing the percentage of patients on pressure support (sum of hours on MV and N-CPAP) in LPI, infants born at 37 weeks of gestation and infants born between 38 and 41 weeks of gestation.

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