Early-Term Birth and Adverse Outcomes

 Shaon Sengupta, MD MBBS MPH Division of Neonatology, Department of Pediatrics Children’s Hospital of Philadelphia, Philadelphia, PennsylvaniaMedicalResearch.com Interview with:
Shaon Sengupta, MD MBBS MPH
Division of Neonatology, Department of Pediatrics
Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
MedicalResearch.com: What are the main findings of the study?

Dr. Sengupta: In this study we looked at all full-term neonates, which are defined as those born between 37 weeks 0 days to 41 weeks 6 days.

Early term deliveries (37–38 weeks) are a significant part of all full-term deliveries, but are not the norm.

In our study, 27% of neonates were born early term (37-38 weeks) while almost 62% were born at or after 39 weeks (term neonates). Similar data has been reported by other established sources of vital statistics.

While traditionally, full term neonates are perceived to be a homogenous low-risk group, the findings from our study urge the pediatrics/neonatal provider to recognize early term (37-38 weeks) neonates as a higher risk group. They have significantly higher risk of NICU admission, respiratory morbidity, hypoglycemia, need for IV fluids and antibiotics.

MedicalResearch.com: Were any of the findings unexpected?

Dr. Sengupta: Although, increased morbidity in the early born full term group (early term) has been known for the past few years, the association was mainly for neonates born via C-Section, especially in elective cases. Out study, clearly documents that the increased morbidity is present for both modes of delivery, vaginal and C-sections.

Furthermore, the Apgar scores at 1 and 5 minutes after birth, cord pH, etc. are not very different, reinforcing the perception that early term neonates may not appear very different in the delivery room, but later go on to develop complications.

MedicalResearch.com: What should clinicians and patients take away from your report?

Dr. Sengupta: For clinicians and the medical community as such, I think acknowledging that the early term group does have higher risk is the most important take away.

It our responsibility then to educate our patients regarding the risks of being born early even if traditionally still within the “full-term” bracket.

As a community, we need to carefully analyze the risk-benefit ratio, taking the above information into account, when taking the decision to delivery early.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Dr. Sengupta: Implementing quality initiatives to reduce early-term deliveries when possible, and thereby reducing overall morbidity in this group, would be important steps in accomplishing this.

Establishing clear and consistent criteria for non-elective induction of labor and C-Sections would be another important direction. There are some reports of long term follow up data for children born early term and future studies characterizing the developmental implications would be valuable.

Citation:

Adverse Neonatal Outcomes Associated With Early-Term Birth

Sengupta S, Carrion V, Shelton J, et al. Adverse Neonatal Outcomes Associated With Early-Term Birth. JAMA Pediatr. 2013;():-. doi:10.1001/jamapediatrics.2013.2581.

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