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Neonatal outcomes and delivery of care for infants born late preterm or moderately preterm: a prospective population-based study
  1. Elaine M Boyle1,
  2. Samantha Johnson1,
  3. Bradley Manktelow1,
  4. Sarah E Seaton1,
  5. Elizabeth S Draper1,
  6. Lucy K Smith1,
  7. Jon Dorling2,
  8. Neil Marlow3,
  9. Stavros Petrou4,
  10. David J Field1
  1. 1Department of Health Sciences, University of Leicester, Leicester, UK
  2. 2Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
  3. 3UCL EGA Institute for Women's Health, London, UK
  4. 4Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
  1. Correspondence to Dr Elaine M Boyle, Department of Health Sciences, University of Leicester, 22-28 Princess Road West, Leicester LE1 6TP, UK; eb124{at}le.ac.uk

Abstract

Objective To describe neonatal outcomes and explore variation in delivery of care for infants born late (34–36  weeks) and moderately (32–33 weeks) preterm (LMPT).

Design/setting Prospective population-based study comprising births in four major maternity centres, one midwifery-led unit and at home between September 2009 and December 2010. Data were obtained from maternal and neonatal records.

Participants All LMPT infants were eligible. A random sample of term-born infants (≥37 weeks) acted as controls.

Outcome measures Neonatal unit (NNU) admission, respiratory and nutritional support, neonatal morbidities, investigations, length of stay and postnatal ward care were measured. Differences between centres were explored.

Results 1146 (83%) LMPT and 1258 (79% of eligible) term-born infants were recruited. LMPT infants were significantly more likely to receive resuscitation at birth (17.5% vs 7.4%), respiratory (11.8% vs 0.9%) and nutritional support (3.5% vs 0.3%) and were less likely to be fed breast milk (64.2% vs 72.2%) than term infants. For all interventions and morbidities, a gradient of increasing risk with decreasing gestation was evident. Although 60% of late preterm infants were never admitted to a NNU, 83% required medical input on postnatal wards. Clinical management differed significantly between services.

Conclusions LMPT infants place high demands on specialist neonatal services. A substantial amount of previously unreported specialist input is provided in postnatal wards, beyond normal newborn care. Appropriate expertise and planning of early care are essential if such infants are managed away from specialised neonatal settings. Further research is required to clarify optimal and cost-effective postnatal management for LMPT babies.

  • prematurity
  • late preterm
  • moderately preterm
  • neonatal outcomes

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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