Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Washington University in St. Louis, St. Louis, Missouri.
Am J Perinatol. 2018 Jun;35(7):599-604. doi: 10.1055/s-0037-1617429. Epub 2017 Dec 29.
Placental insufficiency is associated with neonatal neurologic morbidity and late-term gestations (41-41 weeks). Whether late-term infants are at increased risk of neurologic morbidity compared with term infants (39-40 weeks) remains unclear. We aim to compare risk of neurologic morbidity among late-term and term infants.
This secondary analysis of a single-institution prospective cohort study included all liveborn, nonanomalous singleton term and late-term infants, with data on adverse neonatal outcomes up until 28 days of life. The primary outcome was a neonatal neurologic morbidity composite, defined by having one of these conditions: neonatal seizures, intraventricular hemorrhage, hypoxic-ischemic encephalopathy, and neonatal hypothermic therapy. Secondary outcomes were the composite's individual components and nonneurologic neonatal morbidity. Multivariable logistic regression adjusted for delivery mode, nulliparity, and labor type.
Of 5,529 infants included, 747 were late term and 4,782 were term. The risk of composite neurologic morbidity was not significantly different among late-term or term infants (0.5 vs. 0.6%; adjusted odds ratio: 0.59, 95% confidence interval: 0.21-1.71). Overall neonatal morbidity was not significantly different in the two groups, though late-term infants had a nonsignificantly higher prevalence of respiratory distress syndrome (5.5 vs. 3.3%) and meconium aspiration syndrome (0.7 vs. 0.2%).
Neonatal neurologic morbidity is uncommon after 39 weeks. Risk does not increase after 41 weeks.
胎盘功能不全与新生儿神经系统发病和晚期妊娠（41-41 周）有关。晚期妊娠（41-41 周）婴儿与足月（39-40 周）婴儿相比，神经系统发病风险是否增加尚不清楚。我们旨在比较晚期妊娠和足月婴儿的神经系统发病风险。
这是一项单中心前瞻性队列研究的二次分析，纳入了所有活产、非畸形的单胎足月和晚期妊娠婴儿，数据包括直至 28 天的不良新生儿结局。主要结局是新生儿神经系统发病复合症，定义为以下一种情况：新生儿癫痫发作、脑室内出血、缺氧缺血性脑病和新生儿低温治疗。次要结局是复合症的各个组成部分和非神经系统新生儿发病情况。多变量逻辑回归调整了分娩方式、初产妇和分娩类型。
在纳入的 5529 名婴儿中，747 名是晚期妊娠，4782 名是足月妊娠。晚期妊娠或足月妊娠婴儿的复合神经系统发病风险无显著差异（0.5% vs. 0.6%；调整后的优势比：0.59，95%置信区间：0.21-1.71）。两组的总体新生儿发病情况无显著差异，但晚期妊娠婴儿的呼吸窘迫综合征（5.5% vs. 3.3%）和胎粪吸入综合征（0.7% vs. 0.2%）的患病率略高，但无统计学意义。
39 周后新生儿神经系统发病罕见。41 周后风险不会增加。
