Late Outcomes of Late Preterms

Late Outcomes of Late Preterms

Morse SB, Zheng H, Tang Y, Roth J. Early School-Age Outcomes of Late Preterm Infants. Pediatrics. 2009 Apr;123(4):e622-9. [Full text] [PDF]

OBJECTIVE. Late preterm infants represent a significant portion of preterm deliveries. Until recently, these infants have received little attention because of assumptions that they carry minimal risk for long-term morbidities. The purpose of this study was to compare prekindergarten and kindergarten outcomes among healthy late preterm infants, 34 to 36 weeks' gestation at birth, and healthy term infants, 37 to 41 weeks' gestation at birth.

METHODS. The study sample consisted of singleton infants who were born in Florida between January 1, 1996, and August 31, 1997, with a gestational age between 34 and 41 weeks (N = 161804) with a length of stay >72 hours. Seven early school-age outcomes were analyzed. Outcomes were adjusted for 15 potential confounding maternal and infant variables. Unadjusted and adjusted relative risk with 95% confidence interval was estimated for each outcome by using Poisson regression modeling.

RESULTS. Risk for developmental delay or disability was 36% higher among late preterm infants compared with term infants. Risk for suspension in kindergarten was 19% higher for late preterm infants. The remaining 4 outcomes, disability in prekindergarten at 3 and 4 years of age, exceptional student education, and retention in kindergarten, all carried a 10% to 13% increased risk among late preterm infants. The assessment "not ready to start school" was borderline significant.

CONCLUSIONS. This study suggests that healthy late preterm infants compared with healthy term infants face a greater risk for developmental delay and school-related problems up through the first 5 years of life.

Comments. In 2005, in the workshop sponsored by the National Institute of Child Health and Human Development, an expert panel has suggested that the phrase “near term” be placed with “late preterm” to convey the sense that infants who are born between 34 through 36 weeks of gestation are immature and vulnerable and need close monitoring, evaluation, and follow-up. ( Raju TK, et al. Pediatrics. 2006;118(3): 1207–1214). It is recommended to optimize the care provided for late-preterm infants because they are at risk of immediate complications of prematurity such as respiratory problems, hypoglycemia, hypothermia, feeding disorders and hyperbilirubinemia, and high rate of readmissions as well late neuro-developmental and behavioral disorders. This study provides compelling information that healthy-appearing late preterm infants carry an increased risk for developmental delay and adverse early school-age outcomes compared with healthy term infants. SAA

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