Preterm elective caesarean section and early enteral feeding in gastroschisis

Aims: To evaluate the effect of elective caesarean section (CS) before term and early enteral nutrition on length of parenteral nutrition and hospital stay in infants with gastroschisis. Methods: Retrospective review of all infants with gastroschisis treated in a regional level III hospital from 1993 to 2008. During 1993–97, there was no established standard for management of pregnancy or delivery while a protocol on close foetal monitoring and early elective CS was adhered to for 1998–2008. Introduction of human milk on the first day after complete closure of the abdominal wall and rapid increase was the policy during the whole period. Results: With early elective CS, no foetal deaths occurred after 28‐ week gestational age (GA). Ten infants were born during the first period and 20 during the second period at a median GA (range) of 36.5 (34–40) and 35 (34–37) weeks (p = 0.013). Seven and 20, respectively, were born by CS. Median (range) days before full enteral feeds and hospital stay were 11.5 (7–39) and 13.0 (7–46) (p = 0.85), and 17.5 (12–36) and 22.5 (13–195) (p = 0.67), respectively. One child died of volvulus after discharge. Conclusion: Close surveillance of pregnancy, elective preterm caesarean section, early surgery and active approach to primary closure and early enteral feeds appears to be a safe and effective line of management in gastroschisis.     

Epidemiology of late preterm and early term births – An international perspective

Late preterm (34–36 weeks of gestational age (GA)), and early term (37–38 weeks GA) birth rates among singleton live births vary from 3% to 6% and from 15% to 31%, respectively, across countries, although data from low- and middle-income countries are sparse. Countries with high preterm birth rates are more likely to have high early term birth rates; many risk factors are shared, including pregnancy complications (hypertension, diabetes), medical practices (provider-initiated delivery, assisted reproduction), maternal socio-demographic and lifestyle characteristics and environmental factors. Exceptions include nulliparity and inflammation which increase risks for preterm, but not early term birth. Birth before 39 weeks GA is associated with adverse child health outcomes across a wide range of settings. International rate variations suggest that reductions in early delivery are achievable; implementation of best practice guidelines for obstetrical interventions and public health policies targeting population risk factors could contribute to prevention of both late preterm and early term births.     

Targeted oxygen therapy in special care nurseries: Is uniformity a good thing?

Aim: There is wide variation in the commencement of inspired oxygen (FiO2) and the oxygen saturation (SpO₂) targets set in special care nurseries (SCNs). Evidence supports minimising unnecessary oxygen exposure. Does the introduction of a protocol advocating the uniform approach of commencing FiO2 at 30% and targeting SpO2 of 94–96% for infants ≥33 weeks gestation with respiratory distress reduce oxygen exposure? Methods: A ‘Before After’ study was undertaken in three SCNs. Data were recorded for all infants admitted to the SCNs who required oxygen over a 3‐year period. Infants were analysed in gestational age groups: 33–36 weeks (late preterm) and +37 weeks (term/post‐term). Results: Of the 19 830 infants born, 868 (4%) were treated with oxygen. The introduction of an oxygen‐targeting protocol resulted in a statistically and clinically significant reduction in the proportion of infants who were treated with any oxygen for 1 h or more, 4 h or more and in the proportion who received >30% FiO2 for 1 h or more (all P≤ 0.01). This reduction was significant for infants of both gestational age groups. The median duration of oxygen for term/post‐term infants was reduced from 12 h pre‐protocol to 10 h post‐protocol (P= 0.01); however, no significant difference was found for the preterm group (reduced from 11 to 8 h, P= 0.07). Conclusion: Introduction of a uniform oxygen protocol in SCNs for infants ≥33 weeks gestation with respiratory distress reduces the number of infants receiving oxygen and, in term infants, the duration of oxygen exposure.     

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目的 探讨早期、晚期早产儿与足月儿呼吸窘迫综合征(RDS)的发病趋势和临床特征的差异,为临床合理诊治提供依据。方法 2006年1月至2010年12月在郑州大学第三附属医院住院的963例RDS患儿根据胎龄不同分为早期早产儿组(<34周)679例,晚期早产儿组(34～<37周)204例,足月儿组(≥37周)80例,分别对各组患儿的发病率、入院情况、高危因素、临床诊治、预后及并发症进行比较。结果 RDS的发病率逐年增加,均以早期早产儿占多数,晚期早产儿和足月儿RDS比例有增多趋势;RDS患儿男婴超过女婴(P<0.05),且胎龄和体重越大,男婴比例越高;足月儿RDS组产前糖皮质激素使用率明显低于早产儿组;早产儿发生RDS的高危因素主要有胎膜早破、胎盘异常、母亲妊娠高血压疾病,足月儿发生RDS的高危因素主要是择期剖宫产与感染;晚期早产儿与足月儿RDS的临床诊断和应用肺泡表面活性物质(PS)时间均晚于早期早产儿;足月儿RDS应用机械通气比例明显高于早产儿,其临床治愈率高(P<0.05),在死亡率方面与早产儿组无差别;但并发气胸的比例高于早产儿组(P<0.05)。结论 新生儿呼吸窘迫综合征(NRDS)发病率逐年增高,晚期早产儿和足月儿RDS比例有增多趋势;早期、晚期早产儿与足月儿RDS在性别比例、高危因素、起病特点、治疗反应与并发症方面均存在差异,RDS的诊治需要考虑胎龄因素。足月儿RDS多与择期剖宫产、感染有关,发病相对较晚,容易合并气胸,应引起足够重视。     

晚期早产儿和早期足月儿1岁时神经心理发育水平的随访研究

目的 探讨晚期早产儿和早期足月儿1岁时的神经心理发育水平。方法 选择矫正年龄为1岁的1 257名儿童为研究对象。根据其出生时胎龄分为4组：早期早产儿（胎龄28~33⁺⁶周）、晚期早产儿（胎龄34~36⁺⁶周）、早期足月儿（胎龄37~38⁺⁶周）及完全足月儿（胎龄39~41⁺⁶周）。采用Gesell发展量表评估其神经心理发育水平,比较各组儿童在1岁时神经心理发育状况。结果 4组儿童1岁时5大能区（适应性、大运动、精细动作、语言、个人社交）发育商的差异均有统计学意义（P < 0.05）,且均表现为完全足月儿 > 早期足月儿 > 晚期早产儿 > 早期早产儿的趋势（P < 0.05）;各能区发育迟缓率也均表现为完全足月儿最低,早期早产儿最高（P < 0.05）。与完全足月儿相比,早期足月儿适应能力发育落后的风险增加（OR=1.796,P < 0.05）;晚期早产儿适应能力和精细动作发育落后的风险较高,OR值分别为2.651、2.679（P < 0.05）;早期早产儿适应能力、精细动作和个人社交能力发育落后的风险较高,OR值分别为4.069、3.710、3.515（P < 0.05）。结论 儿童1岁时神经心理发育落后的风险随出生胎龄的增加而降低,呈现剂量反应效应。早期足月儿和晚期早产儿仍然存在不同程度的发育落后,应重视早期足月儿和晚期早产儿的保健随访。     

肺表面活性物质对不同胎龄呼吸窘迫综合征新生儿的疗效

目的 探讨肺表面活性物质(PS)对不同胎龄儿呼吸窘迫综合征(RDS)的疗效差异.方法 选择胎龄28～39周,出生体质量760～3 240 g,经PS治疗的RDS患儿67例.早期组:胎龄28～30周的早期早产儿18例;中期组:胎龄31～33周的中期早产儿28例;晚期组:胎龄34周以上的晚期早产儿和足月儿21例.比较3组PS治疗时RDS的重症程度、PS开始使用时间、第1次使用剂量、总剂量、重复使用例数、氧疗时间、最高吸氧体积分数(FiO2)、机械通气时间等指标.结果 PS治疗时早期组和中期组轻度RDS例数明显多于晚期组(Pa＜0.05).中期组和晚期组重度RDS例数明显多于早期组(Pa＜0.05),PS开始使用时间晚期组明显晚于早、中期组(Pa＜0.05).第1次使用剂量早期组明显多于中、晚期组(Pa＜0.05).使用总剂量和重复使用例数各组间均无统计学差异(Pa＞0.05).机械通气时间早、晚期组明显多于中期组(P=0.040);最高FiO2以晚期组最高(P=0.006).结论 早期早产儿RDS病情轻、开始PS治疗时间早、剂量足,但需氧疗和机械通气时间长;晚期早产儿和足月儿RDS病情危重、开始PS治疗时间晚、剂量不足、需氧疗和机械通气时间长.对晚期早产儿和足月儿RDS治疗应尽早、足量使用PS.     

Neonatal blood glucose concentrations in caesarean and vaginally delivered term infants

Background: Little is known about the glucose concentrations at and after birth of infants delivered by caesarean section (CS), when compared with infants born vaginally (VD). Aim: To compare venous cord blood glucose concentrations of term infants born after elective CS to infants born by VD. We studied the null hypothesis that mode of delivery does not affect neonatal blood glucose values. Methods: We compared cord blood glucose concentrations in healthy term infants born after VD (n = 16) or by elective CS (n = 21). Glucose concentrations were obtained immediately at birth from the umbilical cord. Kruskal–Wallis was used to compare glucose concentrations and demographic variables between the groups. Results: Gestational age was 39.6 ± 0.8 weeks in VD group vs. 38.7 ± 0.9 weeks in CS group, and birthweight was 3359 ± 494 vs. 3500 ± 528 g. Cord blood glucose concentration was higher in VD (81.3 ± 16.9 mg/dL) than CS infants (70.3 ± 9.7 mg/dL, p = 0.039). The change in blood glucose concentration over the first 2‐h of life differed significantly between the two groups, being an increase in CS versus a decrease in VD infants (?3.5 ± 15.2 vs. ?15.4 ± 24.6 mg/dL, p = 0.013). Conclusions: Glucose concentrations in VD infants are higher than in infants born by elective CS without labour.     

Preterm infants' early developmental status is associated with later developmental outcome

Aim: To assess the development of preterm infants from 40 weeks gestational age to 18 months corrected age to identify early predictors of later development. Methods: Fifty‐one infants were involved. Infant development was assessed at 40 and 44 weeks gestational age with the Brazelton neonatal behavioral assessment scale and a self‐regulation scale and at 3, 6, 10, 18 months corrected age with the Bayley Scales of Infant Development. The quality of general movements was assessed at 1 and 3 months corrected age and maternal attachment style at infant’s age of 6 months corrected age with the Relation Scale Questionnaire. Results: At term age and 1‐month corrected age, preterm infants were less mature and had lower levels of self‐regulation than full‐term infants. At 3 months corrected age, a higher proportion of preterm infants (43%) had mildly abnormal motor quality compared to the general population (25%). At all follow‐ups, preterm infants had delayed mental, motor and behavioural development, which was associated with the level of self‐regulation, motor quality and maternal attachment style. Maternal education level was the most predominant background factor related to infant development. Conclusion: Preterm infants show early‐in‐life deviations in self‐regulation, motor quality and development. These deviations are risk factors for later optimal functioning.     

The panorama of cerebral palsy in Sweden part XII shows that patterns changed in the birth years 2007–2010

Aim

This was the 12th population‐based study to explore the epidemiology of cerebral palsy (CP) in western Sweden.

Methods

From 2007 to 2010, there were 104 713 live births in the area. We analysed the birth characteristics, aetiology and neuroimaging findings, calculated the prevalence and compared the results with previous study cohorts.

Results

Cerebral palsy was found in 205 children, corresponding to a crude prevalence of 1.96 per 1000 live births. The gestational age‐specific prevalence for <28 gestational weeks was 59.0 per 1000 live births, 45.7 for 28–31 weeks, 6.0 for 32–36 weeks and 1.2 for >36 weeks. Hemiplegia accounted for 44%, diplegia for 34%, tetraplegia for 5%, dyskinetic CP for 12% and ataxia for 3%. Neuroimaging showed maldevelopment in 12%, white matter lesions in 49%, cortical/subcortical lesions in 15% and basal ganglia lesions in 11%. The aetiology was considered prenatal in 38%, peri/neonatal in 38% and remained unclassified in 24%. CP due to term or near‐term asphyxia had decreased.

Conclusion

A nonsignificant decrease in CP prevalence was seen in term‐born children. Hemiplegia was still the most prevalent CP type, while the prevalence of dyskinetic CP had decreased. One in two children had white matter lesions, indicating late second‐ or early third‐trimester timing.     

Underlying maternal and pregnancy‐related conditions account for a substantial proportion of neonatal morbidity in late preterm infants

Aim

We studied the impact of maternal and pregnancy‐related conditions and the effect of gestational age itself, on the health of infants born late preterm.

Methods

Singletons born in gestational weeks 34 + 0 to 41 + 6 in 1995–2013 in the southern region of Sweden were identified from a perinatal register. We found 14 030 infants born late preterm and 294 814 born at term. A hierarchical system was developed to examine the impact of pregnancy complications. The outcomes studied were as follows: neonatal death, central nervous system (CNS) or respiratory disease, infection, neonatal admission and respiratory support. Odds ratios (OR) and 95% confidence intervals (95% CI) were obtained using logistic regression analyses.

Results

Late preterm infants were at increased risk for all outcomes compared to term infants, with adjusted ORs from 13.1 (95% CI: 12.7–13.6) for neonatal admission to 2.3 (95% CI: 1.8–2.9) for infections. Late preterm birth after preterm prelabour rupture of membranes was associated with an overall lower risk compared to late preterm births due to other causes. Exposure to antepartum haemorrhage or maternal diabetes increased the risk for CNS and respiratory morbidity.

Conclusion

Morbidity decreased in late preterm infants with increasing gestational age. Underlying conditions accounted for a substantial part of the morbidity.     

晚期早产儿呼吸系统疾病患病临床特点

目的：探讨晚期早产儿呼吸系统疾病患病的临床特点。方法：选取2009年1月至2010年12月在我院产科出生的新生儿,其中晚期早产儿 (胎龄34~36+6周)630例,足月儿4401例,早期早产儿（胎龄≤33+6周）328例。其中患呼吸系统疾病者包括晚期早产儿84例,足月儿135例,早期早产儿182例。比较3组新生儿呼吸系统疾病发病情况、临床特点及危重程度。结果：（1）晚期早产儿组呼吸系统疾病发生率、病死率及危重症比例均高于足月儿组,而低于早期早产儿组(P<0.01)。（2）晚期早产儿组呼吸困难起病时间早于足月儿组,晚于早期早产儿组（P<0.01）;呼吸增快百分比较其他两组高,而三凹征百分比较低(P<0.05); 晚期早产儿组需氧疗及机械通气的比例均明显高于足月儿组,而低于早期早产儿组(P<0.05)。（3）多元线性回归分析发现血氧分压降低、红细胞压积减低、血pH值减低、呼吸减慢、动脉血氧饱和度减低、动脉收缩压减低、5 min Apgar评分减低、胎龄较小、血尿素氮增高、心率增快、呼吸增快是新生儿呼吸系统疾病危重症的影响因素。结论：晚期早产儿比足月儿更容易出现呼吸系统疾病,危重程度较重,需加强呼吸支持。晚期早产儿呼吸困难多表现为呼吸增快,起病时间早于足月儿而晚于早期早产儿。对于晚期早产儿,如发现呼吸困难、心率、血压异常及多系统受累表现,常提示其病情危重,应积极治疗。     

Neonatal morbidity in singleton late preterm infants compared with full-term infants

Aim: The aim of this study was to test the hypothesis that singleton late preterm infants (34 0/7 to 36 6/7 weeks of gestation) compared with full‐term infants have a higher incidence of short‐term morbidity and stay longer in hospital. Methods: In this retrospective, multicentre study, electronic data of children born at five hospitals in Switzerland were recorded. Short‐term outcome of late preterm infants was compared with a control group of full‐term infants (39 0/7 to 40 6/7 weeks of gestation). Multiple gestations, pregnancies complicated by foetal malformations, maternal consumption of illicit drugs and infants with incomplete documentation were excluded. The results were corrected for gender imbalance. Results: Data from 530 late preterm and 1686 full‐term infants were analysed. Compared with full‐term infants, late preterm infants had a significant higher morbidity: respiratory distress (34.7% vs. 4.6%), hyperbilirubinaemia (47.7% vs. 3.4%), hypoglycaemia (14.3% vs. 0.6%), hypothermia (2.5% vs. 0.6%) and duration of hospitalization (mean, 9.9 days vs. 5.2 days). The risk to develop at least one complication was 7.6 (95% CI: 6.2–9.6) times higher among late preterm infants (70.8%) than among full‐term infants (9.3%). Conclusion: Singleton late preterm infants show considerably higher rate of medical complications and prolonged hospital stay compared with matched full‐term infants and therefore need more medical and financial resources.     

National birthweight percentiles by gestational age for twins born in Australia

OBJECTIVE: To develop national charts of birthweight percentiles by gestational age and infant sex for liveborn twins born in Australia. METHODOLOGY: National data on live twin births to non-Indigenous Australian-born mothers during 1991-94 were derived from perinatal data collected by midwives in each State and Territory. RESULTS: During 1991-4 there were 20,075 liveborn twin infants. Of these births, missing data included: birthweight 36 (0.2%) births, gestational age 95 (0.5%) births, and sex (missing or indeterminate) 13 (0.06%) births. These births were excluded from the study. An additional 0.6% births were excluded because the recorded birthweights were extreme outliers for the recorded gestational ages. Forty-seven per cent of live twin births were preterm (< 37 weeks). At all gestational ages, the median birthweight of male twins was higher than that of female twins. At model gestational age of 38 weeks, the difference in the median birthweight was 130 g. CONCLUSIONS: The charts produced as a result of the study provide birthweight percentiles by gestational age for twins based on national data in Australia. They provide current population norms for the use of Australian clinicians and researchers.     

晚期早产儿早期智能发育结局的研究

目的探讨晚期早产儿(LPI)早期智能发育结局。方法选择2012年1月至2015年1月新生儿病房收治的出生胎龄34~36+6周、治愈出院并定期规律随访的106例早产儿为晚期早产儿组;随机抽取同期120例健康足月儿(FPI)为对照组。对校正年龄40周的晚期早产儿及40周龄的足月儿进行新生儿神经行为测定(NBNA),晚期早产儿校正龄3、6、12月龄或者足月儿3、6、12月龄时采用Gesell发育量表进行评估。结果 LPI组NBNA评分低于37分,低于FTI组(P0.05)。校正龄3月龄时,LPI组大运动、精细运动、个人社交落后于FTI组(P0.05);校正龄6月龄时,LPI组适应性、大运动、精细运动落后于FTI组(P0.05);校正年龄12月龄时,LPI组适应性、大运动、个人社交测评明显低于FTI组(P0.05)。结论晚期早产儿早期智能发育迟缓,需加强神经发育监测。     

新生儿出生后24小时内凝血功能检测的临床意义分析

目的探讨不同胎龄以及不同体重新生儿凝血功能指标的差异,为判断凝血功能指标的临床意义提供参考。方法2015年1月至2018年12月期间,在解放军总医院第五医学中心新生儿科住院治疗的新生儿中,纳入170例胎龄28~42周、出生8 h内入院的新生儿,其中男性87例,女性83例。按胎龄分为早期早产儿组、晚期早产儿组和足月儿组。按新生儿出生体重分为正常出生体重组、低出生体重组和极低出生体重组。按是否小于胎龄分为早产适于胎龄儿组、早产小于胎龄儿组、足月适于胎龄儿组、足月小于胎龄儿组。于生后24 h内抽取静脉血,检测活化部分凝血活酶时间(activatedpartial thromboplastin time,APTT)、凝血酶原时间(prothrombin time,PT)、纤维蛋白原(fibrinogen,FIB)、凝血酶时间(thrombin,TT)及D-二聚体(D-dimer)。结果早期早产儿组的APTT、PT、D-二聚体水平均高于晚期早产儿组及足月儿组(P值均<0.05),FIB水平低于晚期早产儿组及足月儿组(P值均<0.05);晚期早产儿组的APTT、PT水平均高于足月儿组(P值均<0.05),但两组间D-二聚体、FIB水平比较,差异无统计学意义(P值均>0.05)。极低出生体重组的APTT、PT、D-二聚体水平均高于低出生体重组及正常出生体重组(P值均<0.05),FIB水平低于低出生体重组及正常出生体重组(P值均<0.05);低出生体重组的APTT、PT水平均高于正常出生体重组(P值均<0.05),但两组间D-二聚体、FIB水平比较,差异无统计学意义(P值均>0.05)。早产小于胎龄儿组D-二聚体水平高于早产适于胎龄儿组(P<0.05),其余指标比较差异无统计学意义(P值均>0.05);足月适于胎龄儿与足月小于胎龄儿组的凝血指标比较,差异均无统计学意义(P值均>0.05)。早产儿出血发生率高于足月儿[26.6%(29/109)与8.2%(5/61),χ^2=9.019,P=0.003]。结论新生儿凝血指标有胎龄和体重差异,胎龄越小、体重越低的新生儿凝血功能越不完善。     

Role of the Pediatric Nurse Practitioner in Promoting Breastfeeding for Late Preterm Infants in Primary Care Settings

The preterm birth rate has been increasing steadily during the past two decades. Up to two thirds of this increase has been attributed to the increasing rate of late preterm births (34 to < 37 gestational weeks). The advantages of breastfeeding for premature infants appear to be even greater than for term infants; however, establishing breastfeeding in late-preterm infants is frequently more problematic. Because of their immaturity, late preterm infants may have less stamina; difficulty with latch, suck, and swallow; temperature instability; increased vulnerability to infection; hyperbilirubinemia, and more respiratory problems than the full-term infant. Late preterm infants usually are treated as full term and discharged within 48 hours of birth, so pediatric nurse practitioners in primary care settings play a critical role in promoting breastfeeding through early assessment and detection of breastfeeding difficulties and by providing anticipatory guidance related to breastfeeding and follow-up. The purpose of this article is to describe the developmental and physiologic immaturity of late preterm infants and to highlight the role of pediatric nurse practitioners in primary care settings in supporting and promoting breastfeeding for late preterm infants.     

The nonimpact of gestational age on neurodevelopmental outcome for ventilated survivors born at 23-28 weeks of gestation

Aim: It has long been known that survival of preterm infants strongly depends upon birth weight and gestational age. This study addresses a different question – whether the gestational maturity improves neurodevelopmental outcomes for ventilated infants born at 23–28 weeks who survive to neonatal intensive care unit (NICU) discharge. Methods: We performed a prospective cohort study of 199 ventilated infants born between 23 and 28 weeks of gestation. Neurodevelopmental impairment was determined using the Bayley Scales of Infant Development‐II at 24 months. Results: As expected, when considered as a ratio of all births, both survival and survival without neurodevelopmental impairment were strongly dependent on gestational age. However, the percentage of surviving infants who displayed neurodevelopmental impairment did not vary with gestational age for any level of neurodevelopmental impairment (MDI or PDI <50, <60, <70). Moreover, as a higher percentage of ventilated infants survived to NICU discharge at higher gestational ages, but the percentage of neurodevelopmental impairment in NICU survivors was unaffected by gestational age, the percentage of all ventilated births who survived with neurodevelopmental impairment rose – not fell – with increasing gestation age. Conclusion: For physicians, parents and policy‐makers whose primary concern is the presence of neurodevelopmental impairment in infants who survive the NICU, reliance on gestational age appears to be misplaced.     

Five‐year survival without major disability of extremely preterm infants born at 22–27 weeks’ gestation admitted to a NICU

Aim: To compare the 5‐year survival without major disability in infants born at the threshold of viability at 22–25 weeks who were actively treated in the delivery room and admitted to a NICU to that of those born at 26–27 weeks of gestation. Methods: All infants between 22⁺⁰ and 27⁺⁶ weeks of gestation admitted to a regional intensive care unit during 1999–2003 were enroled prospectively. The survival and major disability at 5 years of age were analysed by gestational age. Results: Of 242 treated infants, 202 survived (83.5%). Although the overall survival rate was significantly higher in the 25–27 weeks’ gestation infants than the 22–24 weeks’ gestation infants (p < 0.001), the survival rate among infants 22–24 weeks (63.6%, 63.6%, and 70%) did not significantly differ, likewise infants 25–27 weeks (88.7%, 90.6%, and 92%) had similar results. Overall, 28 children (14.4% of assessed) had major disability. Both survival and survival without major disability were positively influenced by increasing gestational age, increasing birth weight, being born at 25–27 weeks and being female child. Conclusion: With an active approach in treatment, the outcome of infants born at 25 weeks is comparable to those born at 26–27 weeks. Thus, the ‘grey zone’ in which the risk of adverse outcome is high narrows to 22–24 weeks.     

Survival of very preterm infants: Epipage, a population based cohort study

OBJECTIVE: To evaluate the outcome for all infants born before 33 weeks gestation until discharge from hospital. DESIGN: A prospective observational population based study. SETTING: Nine regions of France in 1997. PATIENTS: All births or late terminations of pregnancy for fetal or maternal reasons between 22 and 32 weeks gestation. MAIN OUTCOME MEASURE: Life status: stillbirth, live birth, death in delivery room, death in intensive care, decision to limit intensive care, survival to discharge. RESULTS: A total of 722 late terminations, 772 stillbirths, and 2901 live births were recorded. The incidence of very preterm births was 1.3 per 100 live births and stillbirths. The survival rate for births between 22 and 32 weeks was 67% of all births (including stillbirths), 85% of live births, and 89% of infants admitted to neonatal intensive care units. Survival increased with gestational age: 31% of all infants born alive at 24 weeks survived to discharge, 78% at 28 weeks, and 97% at 32 weeks. Survival among live births was lower for small for gestational age infants, multiple births, and boys. Overall, 50% of deaths after birth followed decisions to withhold or withdraw intensive care: 66% of deaths in the delivery room, decreasing with increasing gestational age; 44% of deaths in the neonatal intensive care unit, with little variation with gestational age. CONCLUSION: Among very preterm babies, chances of survival varies greatly according to the length of gestation. At all gestational ages, a large proportion of deaths are associated with a decision to limit intensive care.     

Outcomes of congenital heart disease in late preterm infants: double jeopardy?

Aim: To evaluate outcomes of late preterm (34–36 6/7 weeks gestation) infants with congenital heart defects requiring surgical intervention during initial admission (added), in comparison with term (37–42 weeks) controls. Methods: This was a retrospective chart review of consecutive late preterm and term infants with congenital heart lesions, requiring surgical intervention during initial admission. Results: Our cohort (n = 88) comprised 26 late preterm infants (group 1) and 62 term controls (group 2). The two groups differed significantly in mean (SD) gestation [34.5 (1.5) vs. 39.1 (1) weeks)], birth weight [2335 (402) vs. 3173 (401) g] and weight [2602 (739) vs. 3273 (507) g] and age [33 (51) vs. 11 (14) days] at surgery. Cardiac diagnosis frequencies were similar in both groups. The mean (SD) duration of PGE1 [31.9 (56.8) vs. 11.3 (24.9) days] and need for preoperative pressors (25% vs. 8%) were significantly higher in group 1. Death (23% vs. 8%, p = 0.05) tended to be higher in group 1. Rates of necrotizing enterocolitis (23% vs. 1.7%), seizures (19% vs. 0%), oxygen need (12% vs. 0%) and gavage feeds (12% vs. 1.6%) at discharge were all significantly higher in the late preterm cohort. Conclusions: These data highlight the extreme vulnerability of infants with the ‘double hits’ of prematurity and heart defects.