Risk Factors for Neonatal Morbidity and Mortality Among “Healthy,” Late Preterm Newborns

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Research about neonatal outcomes among late preterm infants (34 weeks through 36 6/7 weeks of gestation) is limited. Understanding which late preterm infants are at risk for neonatal morbidity or mortality is necessary to improve health outcomes and reduce hospital costs. We conducted a population-based cohort study of “healthy,” singleton late preterm infants vaginally delivered in Massachusetts hospitals to Massachusetts residents between 1998 and 2002. We compared the incidence of neonatal morbidity (postdelivery inpatient readmissions, observational stays, or mortality) between “healthy,” late preterm infants with and without infant, obstetric, and sociodemographic factors by calculating risk ratios adjusted for confounding. Of the 9552 late preterm, “healthy” infants, 4.8% had an inpatient readmission and 1.3% had an observational stay. Infants with neonatal morbidity were more likely to be firstborn, be breastfed at discharge, have labor and delivery complications, be a recipient of a public payer source at delivery, or have an Asian/Pacific Islander mother. Non-Hispanic blacks had a decreased risk for neonatal morbidity compared to other racial/ethnic groups. Knowledge of risk factors for neonatal morbidity among “healthy” late preterm infants can be used to identify infants needing closer monitoring and earlier follow-up after hospital discharge.

Section snippets

Methods

Our study design used a population-based cohort of singleton, vaginally delivered, healthy-appearing late preterm infants born to Massachusetts residents in Massachusetts hospitals from January 1, 1998 through November 30, 2002. We obtained data from the Massachusetts Pregnancy to Early Life Longitudinal (PELL) Data System. PELL is a longitudinally linked dataset of mothers and their children from birth onward. PELL includes vital statistics records (birth and death certificates), health

Results

Of the 9552 late preterm, “healthy” infants, 4.8% had an inpatient readmission and 1.3% had an observational stay. Five infants had both an inpatient hospital re-admission and an observational stay. Four infants died in the neonatal period, and of these, 3 infants also had inpatient hospital readmissions.

The characteristics of our study population are described in Table 1. In this study, most of these late preterm infants were born at 36 weeks’ gestation, breastfed at discharge, and stayed in

Discussion

In this population-based study to identify risk factors for neonatal morbidity among “healthy,” singleton late preterm infants, we found that the independent risk factors for neonatal morbidity were: having an Asian/Pacific Islander mother, being firstborn, being breastfed at discharge, having a mother with any reported labor and delivery complications, and having a public payer source at delivery. However, when we stratified by breastfeeding status, we found that breastfed late preterm infants

Acknowledgments

The authors would like to thank the following current and former PELL Team Members for their long hours and dedication to the linkage of the PELL datasets and for ensuring the quality of the linkages. These team members include Angela Nannini, Eugene Declercq, Mary Barger, Howard Cabral, Mark McLaughlin, Karen Clements, Hafsatou Diop, Penny Liu, Emily Lu, and Jane Lazar.

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    Disclaimer: The findings and conclusions in this report are those of the author(s) and do not necessarily represent the views of the funding agency.

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