Stout Molly J, Demaree Devyn, Merfeld Emily, Tuuli Methodius G, Wambach Jennifer A, Cole F Sessions, Cahill Alison G
Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis Children's Hospital, St. Louis, Missouri.
Division of Newborn Medicine, Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, Barnes-Jewish Hospital, St. Louis Children's Hospital, St. Louis, Missouri.
Am J Perinatol. 2018 Apr;35(5):494-502. doi: 10.1055/s-0037-1608804. Epub 2017 Nov 28.
Preterm birth (PTB) at <37 weeks of gestation complicates 10% of pregnancies and requires accurate counseling regarding anticipated neonatal outcomes. PTB classification as spontaneous or indicated is commonly used to cluster PTB into subtypes, but whether neonatal outcomes differ by PTB subtype is unknown. We tested the hypothesis that neonatal morbidity differs based on subtype of PTB.
We performed a retrospective cohort study of live-born, non-anomalous preterm infants from 2004 to 2008. Spontaneous PTB was defined as PTB from spontaneous preterm labor or preterm rupture of membranes. Indicated PTB was defined as PTB from any maternal or fetal medical complication necessitating delivery. The primary outcome was a composite of early respiratory morbidity. Secondary outcomes included late composite respiratory morbidity and other neonatal morbidities.
Of 1,223 preterm neonates, 60.9% were born after spontaneous PTB and 30.1% after indicated PTB. Composite early respiratory morbidity was significantly higher after indicated PTB versus spontaneous PTB (1.3, 95% confidence interval [CI] 1.2-1.4). Composite late respiratory morbidity (1.8, 95% CI 1.3-2.3) and neonatal death (2.8, 95% CI 1.5-5.1) were also significantly higher after indicated PTB versus spontaneous PTB.
Neonatal respiratory outcomes and death differ according to PTB subtype. PTB subtype should be considered while counseling families and anticipating neonatal outcomes after PTB.
妊娠<37周的早产（PTB）使10%的妊娠复杂化，需要就预期的新生儿结局进行准确的咨询。PTB分为自发性或指征性，这一分类常用于将PTB聚类为不同亚型，但PTB亚型的新生儿结局是否不同尚不清楚。我们检验了基于PTB亚型新生儿发病率不同的假设。
我们对2004年至2008年出生的存活、无异常的早产婴儿进行了一项回顾性队列研究。自发性PTB定义为自发性早产或胎膜早破导致的PTB。指征性PTB定义为因任何母体或胎儿医学并发症而必须分娩导致的PTB。主要结局是早期呼吸系统发病率的综合指标。次要结局包括晚期呼吸系统发病率综合指标和其他新生儿疾病。
在1223例早产新生儿中，60.9%为自发性PTB后出生，30.1%为指征性PTB后出生。与自发性PTB相比，指征性PTB后的早期呼吸系统发病率综合指标显著更高（1.3，95%置信区间[CI]1.2 - 1.4）。与自发性PTB相比，指征性PTB后的晚期呼吸系统发病率综合指标（1.8，95%CI 1.3 - 2.3）和新生儿死亡（2.8，95%CI 1.5 - 5.1）也显著更高。
新生儿呼吸结局和死亡因PTB亚型而异。在为家庭提供咨询以及预测PTB后的新生儿结局时，应考虑PTB亚型。
