Erin B Kennedy1, Michele R Hacker2,3, David Miedema1, DeWayne M Pursley1, Anna M Modest2, Toni H Golen2, Heather H Burris4,5. 1. Departments of Neonatology and. 2. Obstetrics, Gynecology, and Reproductive Biology, Beth Israel Deaconess Medical Center and Harvard Medical School and. 3. Department of Epidemiology, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts; and. 4. Departments of Neonatology and burrish@email.chop.edu. 5. Department of Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
Abstract
BACKGROUND AND OBJECTIVES: 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. METHODS: 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. RESULTS: 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% (P < .0001). NICU admissions decreased nonsignificantly (9.2% to 8.8%; P = .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; P = .46). CONCLUSIONS: 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.
BACKGROUND AND OBJECTIVES: 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. METHODS: 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. RESULTS: 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% (P < .0001). NICU admissions decreased nonsignificantly (9.2% to 8.8%; P = .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; P = .46). CONCLUSIONS: 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.
Authors: Freke A Wilmink; Chantal W P M Hukkelhoven; Simone Lunshof; Ben Willem J Mol; Joris A M van der Post; Dimitri N M Papatsonis Journal: Am J Obstet Gynecol Date: 2010-03 Impact factor: 8.661
Authors: Steven L Clark; Darla D Miller; Michael A Belfort; Gary A Dildy; Donna K Frye; Janet A Meyers Journal: Am J Obstet Gynecol Date: 2008-12-25 Impact factor: 8.661
Authors: Vicki Flenady; Aleena M Wojcieszek; Philippa Middleton; David Ellwood; Jan Jaap Erwich; Michael Coory; T Yee Khong; Robert M Silver; Gordon C S Smith; Frances M Boyle; Joy E Lawn; Hannah Blencowe; Susannah Hopkins Leisher; Mechthild M Gross; Dell Horey; Lynn Farrales; Frank Bloomfield; Lesley McCowan; Stephanie J Brown; K S Joseph; Jennifer Zeitlin; Hanna E Reinebrant; Joanne Cacciatore; Claudia Ravaldi; Alfredo Vannacci; Jillian Cassidy; Paul Cassidy; Cindy Farquhar; Euan Wallace; Dimitrios Siassakos; Alexander E P Heazell; Claire Storey; Lynn Sadler; Scott Petersen; J Frederik Frøen; Robert L Goldenberg Journal: Lancet Date: 2016-01-19 Impact factor: 79.321