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Late Preterm Birth: Who are these babies and how do they fare?

Late Preterm Birth: Who are these babies and how do they fare?. Nancy S. Green, MD Medical Director, March of Dimes Associate Professor Pediatrics Assistant Professor Cell Biology Albert Einstein College of Medicine. 12/05 MCH Epi. Background. U.S. PTB has increased more than 30%

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Late Preterm Birth: Who are these babies and how do they fare?

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  1. Late Preterm Birth: Who are these babies and how do they fare? Nancy S. Green, MD Medical Director, March of Dimes Associate Professor Pediatrics Assistant Professor Cell Biology Albert Einstein College of Medicine 12/05 MCH Epi

  2. Background • U.S. PTB has increased more than 30% • Factors associated with PTB increasing: multiples, C-sections, inductions • Very preterm birth rate constant • Recent studies: 34-36 weeks increased risk for certain morbidities

  3. Definitions • Preterm birth: • < 37 completed weeks gestation • Late preterm (or Near- Term): • 34-36 or 35-36 completed weeks • Very preterm: • <32 completed weeks

  4. Distribution of singleton preterm births U. S. 2002 34-36 Weeks: - 74% of all singleton PTB - 7.5% of all births March of Dimes Perinatal Data Center, 2005

  5. Who are these infants? Late preterm (34-36 wks) • ~3/4 of all singleton preterm infants (34-36 weeks) • 7.5% of all U.S. births (2003) • Group rising in numbers over last decade • Definition • Often defined by the Obstetric cut-off for Respiratory Distress and maternal antenatal steroids = 34 weeks • Clinical management: • Often go to the “normal nursery”

  6. Higher rates of c-sections and inductions among singleton live births: 1992 and 2002 34-36.6 weeks in 2002: C/S: ~ 28% Induction: ~ 18% C-sections Inductions March of Dimes Perinatal Data Center, 2005

  7. Race/ Ethnicity Comparison: Singleton Live Births and Preterm Births,U.S., 2002 14% 22% 57% 50% 22% 22%

  8. Differences in Singleton Preterm Birth Rates by Race/Ethnicity, 1992 and 2002 Source: National Center for Health StatisticsPrepared by the March of Dimes Perinatal Data Center, November 2005.

  9. Detailed Differences in Singleton Preterm Birth Rates by Race/Ethnicity, 1992 and 2002 Source: National Center for Health StatisticsPrepared by the March of Dimes Perinatal Data Center, November 2005.

  10. What Impact to Infant Health from Rising Late PTB? Need to separate causes and effects • Increased morbidities - Higher Neonatal and Infant mortality: • U.S. neonatal deaths/1000 live births (2002) • 34-36 weeks = 4.1 • 37-41 weeks =0.9 • U.S. infant deaths/1000 live births (2002) • 34-36 weeks = 7.7 • 37-41 weeks = 2.5

  11. What morbidities associated with Late PTB? • Increased immediate morbidities: • Respiratory distress • Jaundice • Feeding difficulties • Hypoglycemia • Temperature instability • Sepsis • Increased NICU use (and re-admissions) • Increased cost • Long term outcome - ?? - NO DATA!

  12. Length of Hospital Stay:Full term vs. Near term Wang, et al. Pediatrics, 2004 Wang, et al. Pediatrics, 2004

  13. Frequency of RDS, sepsis and apnea: 34, 35, 36 weeks of gestation Arnon, et al. Paediatr Perinat Epidemiol, 2001

  14. Clinical Outcomes: Full term vs. Near term Wang, et al. Pediatrics, 2004

  15. Near Term Births:Excess hospital costs Gilbert, et al. Obstetrics Gynecology, 2003

  16. Multivariant Model for Re-hospitalizations(Kaiser) Adapted from: Escobar, et al. Arch Dis Child, 2005

  17. Near-term Infants:Hyperbilirubinemia (Jaundice) - 2 reports 4/11 (36%) of infants in an HMO with serum bilirubin of 30+ were born at 35-36 weeks Newman, Pediatrics 2003 Sarici, Pediatrics 2004(Turkey)

  18. Morbidities of the Near-term Infant At one tertiary medical center - 34 week babies represented: • 1.6% of deliveries • 7% of NICU admissions • 19% of NICU bed-days Gladstone, Am J Perinatol 2004

  19. Moderately Preterm Infants: “Underprivileged Newborns”[32-26 weeks] Amiel-Tison et al, 2002

  20. M. Klebanoff, 2004 Clinical Issues • Prolonging a high-risk pregnancy to 32-36 weeks versus shortening a less high-risk pregnancy from term • Mortality/morbidity may or may not have been less had the pregnancy continued (or been allowed to continue) to term • These infants may need more attention in the nursery • All infants, not just those in NICU • Medical and socio-economic risk

  21. Current Activities - MOD • NICHD meeting - July, 2005 • Special supplement in Seminars in Perinatology • M. Davidoff, et al - Epidemiology • Discussions with potential federal and academic collaborators for more research on short and long-term morbidities • Collaborations with AAP, AWHONN, others re. research and clinical considerations

  22. Michael Davidoff, MPH Joann Petrini, PhD, MPH Vani Bettegowda, MHS Karla Damus, PhD, MSPH Todd Dias, MS Rebecca Russell, MSPH Mark Klebanoff, MD, MPH - NICHD Contributors

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