Improving birth outcomes in
premature babies. Late preterm infants: birth outcomes and healthcare utilization in the
Background. Late preterm infants are born 4
to 6 weeks early. They are very common and comprise 12% of all births in
the U.S. To the casual observer, they are very similar to term infants,
but they are at risk for worse outcomes because they are immature. They
have feeding problems, difficulties with yellow jaundice, difficulties
with low blood sugar, and respiratory difficulties. More importantly,
most studies have shown they are at an increased risk of death both
before and after discharge from the nursery. Further, there are many
obstetrical decisions during the final weeks of pregnancy that involve
the risks and benefits of delivering a baby early versus the risks of
delaying delivery. Most studies to date, however, have been unable to
separate the effects of delivering early and the effects of congenital
anomalies and obstetrical complications that lead to early delivery.
Advance. This study used a novel statistical
method called propensity scoring to clearly separate the effects of
early delivery itself from other factors such as obstetrical
complications and congenital anomalies. When these other factors were
taken into account, the effects of late preterm delivery itself were
much less marked. For example, one study found a 44 fold increase in
death in babies born 4 - 6 weeks early, while this study found only a
slight, almost insignificant increase in death in this population when
all other factors are taken into account.
Grant Support. This study was supported by
the NCRR COBRE P20 RR20146, Arkansas Children's Hospital Research
Institute, and the Tobacco Settlement Proceeds Act of 2000. COBRE funds
allowed protected time and data analysis for one of the authors who
contributed to the interpretation of data.
Public Health Impact/Significance. This
study will allow obstetricians to make better informed decisions
regarding when to intervene in the last few weeks of pregnancy.
Institution and State. This work was
preformed at the Arkansas Children's Hospital Research Institute and the
University of Arkansas for Medical Sciences in Arkansas.