Late prematurity: a systematic review

Machado, Luís Carlos; Passini Júnior, Renato; Rosa, Izilda Rodrigues Machado

doi:10.1016/j.jped.2013.08.012

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Artigos de revisão • J. Pediatr. (Rio J.) 90 (02) • May-Jun 2014 • https://doi.org/10.1016/j.jped.2013.08.012 linkcopy

Late prematurity: a systematic review^☆,^☆☆

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstracts

OBJECTIVE: this study aimed to review the literature regarding late preterm births (34 weeks to 36 weeks and 6 days of gestation) in its several aspects.

SOURCES: the MEDLINE, LILACS, and Cochrane Library databases were searched, and the references of the articles retrieved were also used, with no limit of time.

DATA SYNTHESIS: numerous studies showed a recent increase in late preterm births. In all series, late preterm comprised the majority of preterm births. Studies including millions of births showed a strong association between late preterm birth and neonatal mortality. A higher mortality in childhood and among young adults was also observed. Many studies found an association with several neonatal complications, and also with long-term disorders and sequelae: breastfeeding problems, cerebral palsy, asthma in childhood, poor school performance, schizophrenia, and young adult diabetes. Some authors propose strategies to reduce late preterm birth, or to improve neonatal outcome: use of antenatal corticosteroids, changes in some of the guidelines for early delivery in high-risk pregnancies, and changes in neonatal care for this group.

CONCLUSIONS: numerous studies show greater mortality and morbidity in late preterm infants compared with term infants, in addition to long-term disorders. More recent studies evaluated strategies to improve the outcomes of these neonates. Further studies on these strategies are needed.

Preterm labor; Early neonatal mortality; Neonatal mortality; Infant mortality; High-risk pregnancy

Complications	Authors
	Hernández-Díaz et al. ^{38 , a} OR (95% CI)	Santos et al.^{11 , b} RR (95% CI)	Melamed et al. ^{40 ,c} % (p)	Dani et al.^{39 , d} RR (95% CI)	Consortium on Safe Labor et al.,^{37 , e} OR (95% CI)	Teune et al. ^{14, f} RR (95% CI)	Araújo et al. ^{13, d} OR (95% CI)
Hyaline membrane			4.2 x 0.1 (< 0.001)	7.5 (3.4-16.7)	40.1 (32.0-50.3)	17.3 (9.8-30.6)	4.0 (3.6-4.5)
Transient tachypnea			8.6 x 0.9 (< 0.001)		14.7 (11.7-18.8)		48.5 (19.3-122.5)
Pulmonary hypertension	3.7 (2.3-6.0)		0.2 x 0.03 (< 0.02)
Pneumonia			0.7 x 0.1 (< 0.001)		7.6 (5.2-11.2)		4.3 (1.6-11.5)
Apnea			1.8 x 0.2 (< 0.001)			15.7 (11.8-20.9)	23.3 (5.3-102.6)
Pneumothorax			1.0 x 0.1 (< 0.001)			3.4 (1.8-6.4)
Septicemia			0.4 x 0.04 (< 0.001)			5.6 (1.3-24.2)
Intraventricular hemorrhage			0.2 x 0.02 (< 0.001)			4.9 (2.1-11.7)
Necrotizing enterocolitis						7.5 (3.3-17.3)
Jaundice with phototherapy			18 x 2.5 (< 0.001)	3.0 (2.2-4.0)		5.0 (1.7-14.6)
Hypoglycemia			6.8 x 0.4 (< 0.001)	12.4 (10.1-15.4)		7.4 (3.0-18.1)	5.9 (3.6-9.5)
Hypocalcemia				13.2 (4.8-36.5)
Hypothermia			0.7 x 0.1 (< 0.001)			10.8 (4.6-25.0)
Feeding difficulties				2.7 (1.2-6.2)		6.5 (2.5-16.9)
Need for neonatal resuscitation							2.3 (1.5-2.4)
Apgar < 7 at the 5^th minute		2.6 (1.4-4.9)					2.7 (1.1-6.5)
Overall neonatal morbidity		2.8 (2.3-3.5)
Neonatal ICU admission		1.6 (1.2-2.1)	19.7 x 2.8 (< 0.001)	19.8 (8.7-44.8)			25.2 (16.2-39.1)
Prolonged hospitalization			18.7 x 1.9 (< 0.001)	3.5 (2.8-4.4)

Authors	Outcome
	Neonatal Mortality	Mortality in the first year of life	Mortality in young adult age (18 to 36 years)
Kramer et al. ⁴³ (USA)^a	OR 2.9 (2.8-3.0)	-	-
Kramer et al., ⁴³(Canada) ^a	OR 4.8 (4.0-5.0)	-	-
Santos et al. ^{11 , b}	RR 5.1 (1.7-14.9)	RR 2.1 (1.0-4.6)	-
Guasch et al., ^{25 , c}	OR 4.7 (2.3-9.5)	-	-
Crump et al. ^{44 , a}	-	-	HR 1.3 (1.1-1.5)
Teune et al. ^{14 , d}	RR 5.9 (5.0-6.0)	RR 3.7 (2.9-4.6)	-
Araújo et al. ^{13 , c}	OR 9.1 (2.4-33.9)	-	-

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[TFN01t01] ^CI
, confidence interval

[TFN02t01] ^ICU
, intensive care unit

[TFN03t01] ^OR
, odds ratio

[TFN04t01] ^RR
, relative risk

[TFN05t01] ^Obs
.: all studies shown in the table are observational.

[TFN06t01] ^a
malformations were excluded, but risk pregnancies or multiple gestations were not excluded; control for confounding variables was performed, including multiple gestations.

[TFN07t01] ^b
malformations or risk pregnancies were not excluded, but multiple gestations were excluded and control for confounding variables was performed.

[TFN08t01] ^c
malformations and risk pregnancies, multiple gestations, several indications for cesarean section and all forceps births were excluded; control for confounding variables was performed.

[TFN09t01] ^d
malformations, risk pregnancies or multiple gestations were not excluded and control for confounding variables was not performed.

[TFN10t01] ^e
multiple gestations, high-risk pregnancies or malformations were not excluded; control for confounding variables was performed, including for malformations and multiple gestations.

[TFN11t01] ^f
meta-analysis study.

Late prematurity: a systematic review☆,☆☆

Abstracts

Late prematurity: a systematic review^☆,^☆☆