Department of Health Sciences, University of Leicester, Leicester, UK.
Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.
Arch Dis Child Fetal Neonatal Ed. 2015 Nov;100(6):F479-85. doi: 10.1136/archdischild-2014-307347. Epub 2015 Apr 1.
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.
All LMPT infants were eligible. A random sample of term-born infants (≥37 weeks) acted as controls.
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.
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.
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.
描述新生儿结局，并探讨晚期（34-36 周）和中度早产儿（LMPT，32-33 周）分娩时护理的差异。
设计/背景：本前瞻性基于人群的研究包括 2009 年 9 月至 2010 年 12 月期间在四个主要妇产中心、一个助产士主导的单位和家中分娩的婴儿。数据来自母婴记录。
所有 LMPT 婴儿均符合条件。随机抽取的足月出生婴儿（≥37 周）作为对照。
新生儿病房（NNU）入院、呼吸和营养支持、新生儿并发症、检查、住院时间和产后病房护理。探索了中心之间的差异。
共招募了 1146 名（83%）LMPT 和 1258 名（符合条件的 79%）足月出生婴儿。LMPT 婴儿出生时更有可能需要复苏（17.5%比 7.4%）、呼吸支持（11.8%比 0.9%）和营养支持（3.5%比 0.3%），而母乳喂养的可能性较小（64.2%比 72.2%）。对于所有干预措施和并发症，随着胎龄的降低，风险呈梯度增加。尽管 60%的晚期早产儿从未入住新生儿病房，但 83%的婴儿在产后病房需要医疗干预。各服务之间的临床管理存在显著差异。
LMPT 婴儿对专科新生儿服务需求较高。在产后病房提供了大量以前未报告的专科支持，超出了正常新生儿护理的范围。如果将此类婴儿管理在专门的新生儿环境之外，就需要适当的专业知识和早期护理规划。需要进一步研究以明确 LMPT 婴儿的最佳和具有成本效益的产后管理方法。
