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Avoiding late preterm deliveries to reduce neonatal complications: an 11-year cohort study
BACKGROUND: Late preterm (LPT) newborns, defined as those born between 34 0/7 and 36 6/7 gestational weeks, have higher short- and long-term morbidity and mortality than term infants (≥37 weeks). A categorization to justify a non-spontaneous LPT delivery has been proposed to distinguish evidence-bas...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5759878/ https://www.ncbi.nlm.nih.gov/pubmed/29310615 http://dx.doi.org/10.1186/s12884-017-1650-8 |
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author | Bouchet, Noémie Gayet-Ageron, Angèle Lumbreras Areta, Marina Pfister, Riccardo Erennio Martinez de Tejada, Begoña |
author_facet | Bouchet, Noémie Gayet-Ageron, Angèle Lumbreras Areta, Marina Pfister, Riccardo Erennio Martinez de Tejada, Begoña |
author_sort | Bouchet, Noémie |
collection | PubMed |
description | BACKGROUND: Late preterm (LPT) newborns, defined as those born between 34 0/7 and 36 6/7 gestational weeks, have higher short- and long-term morbidity and mortality than term infants (≥37 weeks). A categorization to justify a non-spontaneous LPT delivery has been proposed to distinguish evidence-based from non-evidence-based criteria. This study aims to describe rates and temporal trends of non-spontaneous LPT neonates delivered according to evidence-based or non-evidence-based criteria and to evaluate the number of avoidable LPT deliveries, including severe neonatal morbidity rates and associated risk factors. METHODS: Retrospective cohort study including all LPT neonates born at a Swiss university maternity unit between January 1, 2002 and December 31, 2012. Trends of LPT neonates and neonatal complications were assessed across time using Poisson regression and risk factors for neonatal complications by logistic regression. RESULTS: Among 40,609 singleton live births, 4223 (10.5%) were preterm and 2017 (4.9%) LPT. In the latter group, 26.2% were non-spontaneous (evidence-based: 12.0%; non-evidence-based: 14.2%). The most frequent indications for evidence-based non-spontaneous LPT delivery were severe preeclampsia (51.8%) and abnormal fetal tracing (24.7%). Indications for non-evidence-based non-spontaneous LPT deliveries were hemorrhage (36.2%) and mild preeclampsia (15.7%). LPT birth rates remained stable over time. The rate of neonatal complications after non-evidence-based LPT birth remained high over time (43.8% vs. 43.5% in 2002 and 2012, respectively; P = 0.645), whereas the annual proportion of neonatal complications overall showed a decreasing trend (from 38.0% in 2002 to 33.5% in 2012; P = 0.051). CONCLUSIONS: LPT birth rates were stable over time, but neonatal complications remained high, particularly after non-evidence-indicated LPT birth. A total of 287 LPT births could have been potentially avoided if an evidence-based protocol for delivery indications had been used. Efforts should be made to avoid non-spontaneous LPT births in order to reduce neonatal complications. |
format | Online Article Text |
id | pubmed-5759878 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-57598782018-01-16 Avoiding late preterm deliveries to reduce neonatal complications: an 11-year cohort study Bouchet, Noémie Gayet-Ageron, Angèle Lumbreras Areta, Marina Pfister, Riccardo Erennio Martinez de Tejada, Begoña BMC Pregnancy Childbirth Research Article BACKGROUND: Late preterm (LPT) newborns, defined as those born between 34 0/7 and 36 6/7 gestational weeks, have higher short- and long-term morbidity and mortality than term infants (≥37 weeks). A categorization to justify a non-spontaneous LPT delivery has been proposed to distinguish evidence-based from non-evidence-based criteria. This study aims to describe rates and temporal trends of non-spontaneous LPT neonates delivered according to evidence-based or non-evidence-based criteria and to evaluate the number of avoidable LPT deliveries, including severe neonatal morbidity rates and associated risk factors. METHODS: Retrospective cohort study including all LPT neonates born at a Swiss university maternity unit between January 1, 2002 and December 31, 2012. Trends of LPT neonates and neonatal complications were assessed across time using Poisson regression and risk factors for neonatal complications by logistic regression. RESULTS: Among 40,609 singleton live births, 4223 (10.5%) were preterm and 2017 (4.9%) LPT. In the latter group, 26.2% were non-spontaneous (evidence-based: 12.0%; non-evidence-based: 14.2%). The most frequent indications for evidence-based non-spontaneous LPT delivery were severe preeclampsia (51.8%) and abnormal fetal tracing (24.7%). Indications for non-evidence-based non-spontaneous LPT deliveries were hemorrhage (36.2%) and mild preeclampsia (15.7%). LPT birth rates remained stable over time. The rate of neonatal complications after non-evidence-based LPT birth remained high over time (43.8% vs. 43.5% in 2002 and 2012, respectively; P = 0.645), whereas the annual proportion of neonatal complications overall showed a decreasing trend (from 38.0% in 2002 to 33.5% in 2012; P = 0.051). CONCLUSIONS: LPT birth rates were stable over time, but neonatal complications remained high, particularly after non-evidence-indicated LPT birth. A total of 287 LPT births could have been potentially avoided if an evidence-based protocol for delivery indications had been used. Efforts should be made to avoid non-spontaneous LPT births in order to reduce neonatal complications. BioMed Central 2018-01-08 /pmc/articles/PMC5759878/ /pubmed/29310615 http://dx.doi.org/10.1186/s12884-017-1650-8 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Bouchet, Noémie Gayet-Ageron, Angèle Lumbreras Areta, Marina Pfister, Riccardo Erennio Martinez de Tejada, Begoña Avoiding late preterm deliveries to reduce neonatal complications: an 11-year cohort study |
title | Avoiding late preterm deliveries to reduce neonatal complications: an 11-year cohort study |
title_full | Avoiding late preterm deliveries to reduce neonatal complications: an 11-year cohort study |
title_fullStr | Avoiding late preterm deliveries to reduce neonatal complications: an 11-year cohort study |
title_full_unstemmed | Avoiding late preterm deliveries to reduce neonatal complications: an 11-year cohort study |
title_short | Avoiding late preterm deliveries to reduce neonatal complications: an 11-year cohort study |
title_sort | avoiding late preterm deliveries to reduce neonatal complications: an 11-year cohort study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5759878/ https://www.ncbi.nlm.nih.gov/pubmed/29310615 http://dx.doi.org/10.1186/s12884-017-1650-8 |
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