Melamed Nir, Klinger Gil, Tenenbaum-Gavish Kinneret, Herscovici Tina, Linder Nehama, Hod Moshe, Yogev Yariv
From the Helen Schneider Hospital for Women and Nursery, Rabin Medical Center, Department of Neonatal Intensive Care, Schneider Children's Medical Center of Israel Petach Tikva, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Obstet Gynecol. 2009 Aug;114(2 Pt 1):253-260. doi: 10.1097/AOG.0b013e3181af6931.
To estimate the effect of gestational age on short-term neonatal morbidity in cases of spontaneous, low-risk singleton late preterm deliveries and to identify predictors of adverse neonatal outcome.
This was a retrospective study of all spontaneous, low-risk late preterm deliveries (34 0/7 to 36 6/7 weeks of gestation) during the years 1997 to 2006 (n=2,478). Multiple gestations and pregnancies complicated by preterm premature rupture of membranes (PROM) or maternal or fetal complications were excluded. Short-term neonatal outcome was compared with a control group of full-term deliveries in a 3:1 ratio (n=7,434). Logistic regression analysis was used to identify risk factors for neonatal morbidity among late preterm infants.
Compared with full-term infants, spontaneous late preterm delivery was independently associated with an increased risk of neonatal morbidity, including respiratory distress syndrome (4.2% compared with 0.1%, P<.001), sepsis (0.4% compared with 0.04%, P<.001), intraventricular hemorrhage (0.2% compared with 0.02%, P<.001), hypoglycemia (6.8% compared with 0.4%, P<.001), and jaundice requiring phototherapy (18% compared with 2.5%, P<.001). Cesarean delivery (odds ratio [OR] 2.1, 95% confidence interval [CI] 1.6-2.6), male sex (OR 1.4, 95% CI 1.1-1.8), and multiparity (OR 2.2, 95% CI 1.7-2.8) were independent risk factors for neonatal respiratory morbidity in cases of late preterm deliveries. The relationship between gestational age and neonatal morbidity was of continuous nature with a nadir at about 39 weeks rather than a term-preterm threshold phenomenon and was unrelated to birth weight.
Late prematurity is associated with significant neonatal morbidity in cases of spontaneous low-risk singleton deliveries. This information is important for appropriate counseling and should stimulate efforts to decrease the rate of late preterm deliveries.
II.
评估孕周对自然分娩、低风险单胎晚期早产新生儿短期发病率的影响，并确定不良新生儿结局的预测因素。
这是一项对1997年至2006年期间所有自然分娩、低风险晚期早产（妊娠34 0/7至36 6/7周）病例的回顾性研究（n = 2478）。排除多胎妊娠以及合并早产胎膜早破（PROM）或母婴并发症的妊娠。将短期新生儿结局与足月分娩对照组按3:1的比例进行比较（n = 7434）。采用逻辑回归分析确定晚期早产儿中新生儿发病的危险因素。
与足月儿相比，自然分娩的晚期早产与新生儿发病风险增加独立相关，包括呼吸窘迫综合征（4.2% 对比0.1%，P <.001）、败血症（0.4% 对比0.04%，P <.001）、脑室内出血（0.2% 对比0.02%，P <.001）、低血糖（6.8% 对比0.4%，P <.001）以及需要光疗的黄疸（18% 对比2.5%，P <.001）。剖宫产（比值比[OR] 2.1，95% 置信区间[CI] 1.6 - 2.6）、男性（OR 1.4，95% CI 1.1 - 1.8）和经产妇（OR 2.2，95% CI 1.7 - 2.8）是晚期早产分娩中新生儿呼吸疾病的独立危险因素。孕周与新生儿发病率之间的关系是连续性的，最低点约在39周，而非足月-早产阈值现象，且与出生体重无关。
在自然分娩、低风险单胎的情况下，晚期早产与显著的新生儿发病率相关。该信息对于适当的咨询很重要，应促使人们努力降低晚期早产的发生率。
II级
