Comparitive Study Of Outcomes Between Late Preterm And Term Babies

Our study compared the morbidity pattern and developmental outcome ( upto six months of age) of babies born late preterm (n= 32) and babies born at term gestation (n = 34) delivered in our Institution during the study period (Nov 2010 to Oct 2011). In the present study,31.2% babies born between 34weeks and 34 weeks+6 days . 25% babies born between 35 weeks and 35weeks+6 days ,43.7% babies born between 36 weeks and 36 weeks+ 6days of gestation. Similar finding has also been reported from Canada by Kitsommart et al 35. 12.5% of babies in the late preterm group were SGA compared to 2.9% in term group. The remaining babies were AGA. No babies were found to be LGA in both groups. This finding is important because late preterm babies born SGA have higher risk of mortality as reported by Pulver. Similar findings have also been reported in the Canadian study35 which found increased morbidities (respiratory distress, hypoglycemia, hyperbilirubinemia, temperature instability and prolonged hospitalization) in late preterms during the early neonatal period (22 % vs. 3 %).

In our study, the late preterm babies required some form of active resuscitation (oxygen supplementation, requirement of bag and mask ventilation) but none required chest compressions or medications for resuscitation. It was also observed that the need for resuscitation was higher for babies born between 34 and 35 weeks gestation as against babies born at 36 weeks or later.

Hence it is better to plan late preterm deliveries in hospitals well equipped with resuscitation facilities, trained manpower and intensive care facilities. Metabolic problems like hypoglycemia was common in late preterm group compared to term babies (6.25% Vs 0%). Even though this observation was not statistically significant, similar observations have been made by Wang et al 21 who reported the incidence of hypoglycaemia to be 15.6 % in late preterms compared to 5.3 % in term babies.

adequate counselling and support all mothers in late preterm group could establish exclusive breast feeding by the time their babies got discharged from the hospital. This finding highlights that these late preterms do develop feeding difficulties if their mothers are not adequately counselled and not given adequate psychological support.

Neonatal hyperbilirubinemia requiring treatment in the form of phototherapy was much higher in late preterm babies as compared to term babies (15.6% vs. 0 %). It was also observed that none of the babies who had jaundice required exchange transfusions or intensive phototherapy. Similar findings have also been reported by other researchers

On follow up for about 6 months it was observed that the 2 babies (6.3%) in the late preterm group had adverse outcome in terms of neurodevelopmental delay and impairment in head growth.

In our study, we did not find respiratory distress syndrome among the late preterms probably because more babies were born close to 36 weeks. Similarly, there was no mortality in our study group. Other complications like Necrotizing enterocolitis, Intraventricular hemorrhage, Patent ductus arteriosus, Perinatal asphyxia and other metabolic problems like polycythemia and hypocalcemia were not seen in our study. In other words, our study differed from other studies by the conspicuous absence of very sick late preterms and hence the absence of mortality in our study. The exclusive breast feeding rates for first six months of life were high (78.1%) in the late preterm group compared to (76.4%) term babies. Although this finding is not statistically significant, it is encouraging to find the higher exclusive breast feeding rates in our study compared to national average. Conclusion: Late preterms are more prone to develop significant short term as well as long term problems that may ultimately influence their outcome. Just because they are born near term, they cannot be treated as term neonates. These babies require close monitoring and supervision immediately after birth and also on a long term basis just like that of a high risk neonate. The treating clinician should have adequate insight in handling late preterms so as to make them lead normal and healthy lives as they grow up.

Limitations of the study

The study population is derived from tertiary care referral center where significant proportions of mothers are referred for complex antenatal problems

Strengths Of The Study

This study is a prospective observational study with a follow up period of 6 months conducted at a tertiary care centre with wide variety of late preterm problems which are addressed in the study.

Enrolment of the late preterms has been done consecutively.