Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden; University Hospital Center Lille, Department of Neonatal Medicine, Jeanne de Flandre Hospital, Lille, France; University of de Paris, Epidemiology and Statistics Research Center/CRESS, French Institute of Health and Medical Research (U1153 - Obstetrical, Perinatal and Pediatric Epidemiology Research Team), National Institute for Agricultural Research, Hospital Tenon, Paris, France.
Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden.
J Pediatr. 2021 Jun;233:43-50.e5. doi: 10.1016/j.jpeds.2021.02.066. Epub 2021 Mar 1.
To assess risk for neonatal morbidities among infants born late preterm at 35-36 gestational weeks, early term (37-38 weeks), and late-term (41 weeks) infants, compared with full-term (39-40 weeks) infants.
This nationwide population-based cohort study included 1 650 450 non-malformed liveborn singleton infants born at 35-41 weeks between 1998 and 2016 in Sweden. The relative risks for low Apgar score (0-3) at 5 minutes; respiratory, metabolic, infectious, and neurologic morbidities; and severe neonatal morbidity (composite outcome) were adjusted for maternal, pregnancy, delivery, and infant characteristics.
Compared with infants born at 39-40 weeks, the adjusted relative risks and proportions of infants born at 35-36 weeks were higher for metabolic morbidity 7.79 (95%, 7.61 to 7.97; 33.75% vs 3.11%), respiratory morbidity 5.54 (95% CI, 5.24 to 5.85; 5.49% vs 0.75%), severe neonatal morbidity 2.42 (95% CI, 2.27 to 2.59; 3.40% versus 1.03%), infectious morbidity 1.98 (95% CI, 1.83 to 2.14; 2.53% vs 0.95%), neurologic morbidity 1.74 (95% CI, 1.48 to 2.03; 0.54% vs 0.23%), and low Apgar score 2.07 (95% CI, 1.72 to 2.51; 0.42% vs 0.12%). The risks for respiratory, severe neonatal morbidity, infectious, neurologic morbidities, and low Apgar score were highest at 35 weeks, gradually decreased until 39 weeks, and increased during 39-41 weeks.
Infants born late preterm at 35-36 weeks of gestation are at increased risk of neonatal morbidities, although the absolute risks for severe neonatal morbidities are low. Our findings reinforce the need of preventing late preterm delivery to decrease the burden of neonatal morbidity and help professionals and families with a better risk assessment.
评估 35-36 孕周晚期早产儿、37-38 孕周足月产儿和 41 孕周足月产儿与 39-40 孕周足月产儿相比，新生儿发病率的风险。
本研究为全国性基于人群的队列研究，纳入了 1998 年至 2016 年间在瑞典出生的 35-41 周非畸形活产单胎婴儿 1650450 例。通过调整母亲、妊娠、分娩和婴儿特征，对低 Apgar 评分（0-3 分）、呼吸、代谢、感染和神经发育不良以及严重新生儿发病率（复合结局）的相对风险进行了调整。
与 39-40 孕周出生的婴儿相比，35-36 孕周出生的婴儿代谢疾病的校正相对风险和比例较高[7.79（95%CI，7.61-7.97；33.75% vs 3.11%）]、呼吸疾病[5.54（95%CI，5.24-5.85；5.49% vs 0.75%）]、严重新生儿发病率[2.42（95%CI，2.27-2.59；3.40% vs 1.03%）]、感染性疾病[1.98（95%CI，1.83-2.14；2.53% vs 0.95%）]、神经发育不良[1.74（95%CI，1.48-2.03；0.54% vs 0.23%）]和低 Apgar 评分[2.07（95%CI，1.72-2.51；0.42% vs 0.12%）]。35 孕周时，呼吸、严重新生儿发病率、感染性疾病、神经发育不良和低 Apgar 评分的风险最高，逐渐下降至 39 孕周，然后在 39-41 孕周时再次升高。
妊娠 35-36 周晚期早产儿发生新生儿发病率的风险增加，尽管严重新生儿发病率的绝对风险较低。我们的研究结果强调了预防晚期早产分娩以降低新生儿发病率负担的必要性，并有助于专业人员和家庭进行更好的风险评估。
