Kennedy Erin B, Hacker Michele R, Miedema David, Pursley DeWayne M, Modest Anna M, Golen Toni H, Burris Heather H
Departments of Neonatology and.
Obstetrics, Gynecology, and Reproductive Biology, Beth Israel Deaconess Medical Center and Harvard Medical School and.
Hosp Pediatr. 2018 Nov;8(11):686-692. doi: 10.1542/hpeds.2018-0068.
Early term infants (37-<39 weeks' gestation) are at higher risk of adverse outcomes than term infants (39-<41 weeks' gestation). We hypothesized that a policy to eliminate elective, early term deliveries would result in fewer NICU admissions and shorter lengths of stay among infants born ≥37 weeks.
This was a retrospective cohort study of singleton infants born ≥37 weeks at a tertiary medical center from 2004 to 2015 (preperiod: 2004-2008; postperiod: 2010-2015; washout period: 2009). We compared the incidence of early term delivery, NICU admissions (short: ≥4-<24 hours, long: ≥24 hours), NICU diagnoses, and stillbirths in both periods. We used modified Poisson regression to calculate adjusted risk ratios.
There were 20 708 and 24 897 singleton infants born ≥37 weeks in the pre- and postperiod, respectively. The proportion of early term infants decreased from 32.5% to 25.7% ( < .0001). NICU admissions decreased nonsignificantly (9.2% to 8.8%; = .22), with a significant reduction in short NICU stays (5.4% to 4.6%; adjusted risk ratio: 0.85 [95% confidence interval: 0.79-0.93]). Long NICU stays increased slightly (3.8% to 4.2%), a result that was nullified by adjusting for neonatal hypoglycemia. A nonsignificant increase in the incidence of stillbirths ≥37 to <40 weeks was present in the postperiod (7.5 to 10 per 10 000 births; = .46).
Reducing early term deliveries was associated with fewer short NICU stays, suggesting that efforts to discourage early term deliveries in uncomplicated pregnancies may minimize mother-infant separation in the newborn period.
早期足月婴儿（妊娠37 - <39周）比足月婴儿（妊娠39 - <41周）发生不良结局的风险更高。我们推测，消除选择性早期足月分娩的政策将减少≥37周出生婴儿入住新生儿重症监护病房（NICU）的人数，并缩短其住院时间。
这是一项对2004年至2015年在一家三级医疗中心出生的≥37周单胎婴儿的回顾性队列研究（前期：2004 - 2008年；后期：2010 - 2015年；洗脱期：2009年）。我们比较了两个时期早期足月分娩的发生率、NICU入院情况（短期：≥4 - <24小时，长期：≥24小时）、NICU诊断以及死产情况。我们使用修正泊松回归来计算调整后的风险比。
前期和后期分别有20708例和24897例≥37周出生的单胎婴儿。早期足月婴儿的比例从32.5%降至25.7%（P <.0001）。NICU入院人数无显著下降（9.2%降至8.8%；P =.22），短期NICU住院时间显著缩短（5.4%降至4.6%；调整后的风险比：0.85 [95%置信区间：0.79 - 0.93]）。长期NICU住院时间略有增加（3.8%升至4.2%），在对新生儿低血糖进行校正后该结果无统计学意义。后期≥37至<40周死产发生率有非显著性增加（每10000例出生中从7.5例升至10例；P =.46）。
减少早期足月分娩与缩短短期NICU住院时间相关，这表明在无并发症的妊娠中努力避免早期足月分娩可能会减少新生儿期母婴分离。
