The transition from intra to extra-uterine life in late preterm infant: a single-center study

Abstract

BackgroundInfants born at 34 to 36 weeks of gestation (late preterm) are at greater risk for adverse outcomes than those born at 37 weeks of gestation or later. Aim of this paper is to examine risk factors for late preterm births and to investigate the complications of the transition period in late preterm infants (LPIs).MethodsAll consecutive late preterm deliveries, excluded stillbirths, were included. Maternal and neonatal data, need for delivery room resuscitative procedures, temperature at birth (T1) and two hours after the admission (T2) were analyzed in all LPIs stratified by Gestational Age (GA) and divided into three groups (34, 35 and 36 weeks).ResultsTwo hundred seventy-six LPIs were analyzed. Pregnancy complications were present in 72 mothers (26.1 %), more frequently at 34 weeks of gestation respect to 35 and 36 weeks (p = 0.008, p = 0.006 respectively). Forty seven LPIs (17.1 %) needed for any resuscitation and 37 (13.4 %) were ventilated at birth. LPIs at 34 weeks were significantly more likely to receive ventilation respect to those at 35 and 36. At T1 the mean temperature resulted lower at 34 weeks respect to 36 weeks (p = 0.03). At T2 respect to T1, the rate of normothermic neonates increased at 35 and 36 weeks (p = 0.003, p = 0.005, respectively).Hypoglicemia rate was similar among the groups; 66.7 % of hypoglicemic neonates were hypothermic at T1. The rate of respiratory diseases and NICU admission decreased with increasing GA. Higher number of neonates ventilated at birth developed respiratory disorders respect to those unventilated (40.5 % vs 8.4 %; p < 0.001).ConclusionsTransition period in LPIs may become critical, as resuscitation strategies can be required and heat loss can occur. LPIs, especially at 34 gestational weeks, are higher-risk group needing adequate and targeted management at birth.

Intercorrências e procedimentos neonatais no recém-nascido pré-termo tardio comparado ao recém-nascido a termo

“…Observamos maior chance de hipoglicemia, 9 especialmente no momento de transição à vida extrauterina, algumas vezes associada ao maior consumo de glicose gerado pelo estresse respiratório, 10 outros casos devem-se à presença de sepse. 11 Foi evidenciado também maior necessidade de suplementação de oxigênio 12 através de pressão positiva contínua nas vias aéreas (CPAP) ou capacete (hood) e maior número de reanimações, 13 quando comparado aos recém--nascidos a termo. Muitos prematuros evoluíram com dificuldade de sucção e/ou deglutição, por conseguinte, necessitando complementação alimentar.…”

Late Preterm Infants: Epidemiological Aspects, Morbidity, and Approaches to Medical Management

“…Частота дыхательных расстройств у поздних недоношенных детей увеличивается с уменьшением ГВ [10,19], с ростом распространенности оперативного родоразрешения [2,10]. Респираторные нарушения при поздних преждевременных родах чаще регистрируются у мальчиков [10]; у детей, родившихся от матерей с высоким уровнем заболеваемости, которым не вводили профилактически кортикостероиды [2,10], от первородящих и от женщин с избыточной массой тела [10].…”

“…Частота респираторного дистресса у младенцев на сроке 34 недели составляет 9%, на сроке 35 недель -4%, на сроке 36 недель -3% [24]. Дети, рожденные в 34 недели, более часто нуждаются в проведении ИВЛ, чем новорожденные с ГВ 35 и 36 недель [19].…”

“…Поздним недоношенным чаще, чем доношенным, необходима госпитализация в отделение реанимации и интенсивной терапии (ОРИТ) [2,8,12,19]. Неинвазивная респираторная поддержка потребовалась 26% поздних недоношенных детей, ИВЛ -10,7%, из них 1,9% -на фоне эндотрахеального введения сурфактанта [18].…”

“…Согласно результатам швейцарского исследования, наиболее частым осложнением при самостоятельных поздних преждевременных родах была тяжелая преэклампсия (51,8%), при оперативных поздних преждевременных родах -кровотечение (36,2%) [15]. На сроке 34 недели регистрируется больше осложнений, чем на сроках 35-36 недель [19].…”