What’s KnOWn On thIs subject: Significant hyperbilirubinemia may be associated with auditory toxicity as manifested by sensorineural hearing loss and/or auditory neuropathy spectrum disorder. Total serum bilirubin and bilirubin albumin molar ratio used for the management of significant hyperbilirubinemia are poor predictors of bilirubin-induced neurotoxicity. What thIs stuDy aDDs: Unbound bilirubin (but not total serum bilirubin or bilirubin albumin molar ratio) is associated with chronic auditory toxicity in late preterm and term infants with significant unconjugated hyperbilirubinemia. Unbound bilirubin is a better predictor of chronic auditory toxicity.
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Although PPHN is often thought to be a disease of postterm infants, our study shows that late preterm infants are at highest risk of PPHN, and early term infants (37–38 weeks) are at higher risk compared with the reference group (39–40 weeks). The incidence of PPHN in this late preterm age group is much higher at 5.4 per 1000 live births and more likely to be due to RDS or infection than in term infants. Our data suggest that clinicians caring for late preterm infants should be aware of the increased risk in this patient group and monitor these infants for PPHN, as its early recognition may avert serious consequences.
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For late preterm compared with term infants, the mean MDI (85 and 89, re- spectively; P ⬍ .0001) and PDI (88 and 92, respectively; P ⬍ .0001) were signiﬁ- cantly lower (Table 3). Similarly, they were more likely to have scores ⬍ 70 on the MDI (21.2% vs 16.4%, respective- ly; P ⫽ .007), but not the PDI (Table 4). When gestational age, plurality, mater- nal race, education, marital status, de- pression, prenatal care, primary lan- guage, infant gender, poverty level, delivery type, fetal growth, and any breast milk feeding were controlled for, the adjusted odds (95% CI) of a late preterm infant having more severe de- velopmental delay (MDI score ⬍ 70) was 1.51 (95% CI: 1.26 –1.82) and milder mental developmental delay (MDI score 70 – 84) was 1.43 (95% CI: 1.22–1.67) compared with a term in- fant. Late preterm infants also had in- creased odds of having more severe psychomotor developmental delay (PDI score ⬍ 70: 1.56 [95% CI: 1.29 – 1.88]) and milder psychomotor devel- opmental delay (PDI score 70 – 84: 1.58 [95% CI: 1.37–1.83]).
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When adjusting for prede ﬁ ned variables, the odds of developmental delay risk based on ASQ scores also increased signiﬁcantly and were inversely related to GA. Compared with those born FT, odds ratios (ORs) were 1.56 (95% conﬁdence interval [CI]: 1.19–2.06) for those born ET, 2.58 (95% CI: 1.66–4.01) for infants born LPT, and 3.01 (95% CI: 1.59–5.71) for those born MPT. The number of affected domains increased as GA decreased. In MPT infants the OR was signi ﬁ cant for all domains except for communication. In LPT infants the OR was signi ﬁ cant for gross and ﬁ ne motor domains, whereas for ET infants the OR was signi ﬁ cant only in gross motor skills (Table 2). There was a trend for linearity between adjusted risk of developmental delay and GA in the 33- to 40-week interval (Fig 2). The x 2 for trend of ORs was 27.33
There are six districts within Xi’an city of Shaanxi province, China. Two of which were randomly selected for this study comprising of 14 community health service centers. The ethics committee of Xi’an Maternal and Child Health Care Hospital approved the study and the statement of informed consent. According to the demographic data, 158 LPIs were eligible for inclusion (all of the children born between 34 + 0 and 36 + 6 weeks of gestation during Oct.1st, 2011 to Sep.30th, 2013). Out of whom, 30 LPIs’ mothers declined to participate in the study and 26 LPIs were unable to be con- tacted. So, only 102 parents/guardians of LPIs were inter- viewed on site with informed consent. One hundred fifty- three term infants (defined as 37–42 weeks’ gestational age and of birth weight between 2.5–4 kg) were randomly re- cruited as the control group during the same period and from the same geographical region.
Genetic differences determine different growth poten- tial and trajectories of boys and girls, thus most growth references and standards have set up growth curves for boys and girls respectively. According to Fenton growth curve, male fetus got slightly more weight increment(- about 5.8 g/week) and almost identical length growth compared with female during 24-36 weeks PMA in uterus . However, sex differences of postnatal growth do not equate to that of fetal growth even under optimal environments. Our male infants got significantly more weight gain than female infants during birth to term-corrected age and the difference was much more obvious than in uterus(male infants outweighed female by about 23 g/week, while length growth was almost identical). Previous data from early and moderate pre- term infants had demonstrated girls’ significantly lower variation of weight gain and incidence of extrauterine growth retardation(EUGR) [4, 34, 35], which were pos- sibly the reflections of girls’ better tolerance of poorer extrauterine environments due to immaturity and subse- quently got better growth results . There was no dif- ference in nutrition risks and feeding modes between male and female subgroups, thus nutrition and feeding could not explain the obvious sex differences in postna- tal weight growth. Further research is needed to clarify whether it is a physiological phenomenon due to genetic differences or potential higher risk of boys to be over- growth than girls in healthy late preterm infants.
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METHODS: Sample included 1000 late preterm, 1800 early term, and 3200 term infants ascertained from the Early Childhood Longitudinal Study, Birth Cohort. Direct assessments of development were performed at 9 and 24 months by using the Bayley Short Form– Research Edition T-scores and at preschool and kindergarten using the Early Childhood Longitudinal Study, Birth Cohort reading and mathematics θ scores. Maternal and infant characteristics were obtained from birth certificate data and parent questionnaires. After controlling for covariates, we compared mean developmental outcomes between late preterm and full-term groups in serial cross-sectional analyses at each timepoint using multilinear regression, with pairwise comparisons testing for group differences by gestational age categories.
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As a consequence, the feeding challenges that the late preterm infants commonly experience lead to a high need for parenteral nutrition and intravenous fluids and place them at risk to be delayed in their discharge to home [8, 14, 15]. Wang et al.  found that the occur- rence of medical problems in infants born with a gesta- tional age of 35–36 6/7 weeks was significantly higher than in infants born at term. Specifically, the authors re- ported that 26.7 % infants born with a gestational age of 35–36 6/7 weeks received intravenous infusions versus 5.3 % of full term infants. In the present study, a moder- ately higher percentage (33.8 %) of infants needed intra- venous fluids whereas 4.4 % needed parenteral nutrition. This finding could be partially explained by the fact that we have enrolled also infants born at 34 weeks of gesta- tional age, that represented the majority of infants re- quiring either intravenous fluids or parenteral nutrition.
Late preterm (LP) infants are de ﬁ ned as those born at 34-0/7 to 36-6/7 weeks ’ gestational age. LP infants were previously referred to as near term infants. The change in terminology resulted from the under- standing that these infants are not fully mature and that the last 6 weeks of gestation represent a critical period of growth and devel- opment of the fetal brain and lungs, and of other systems. There is accumulating evidence of higher risks for health complications in these infants, including serious morbidity and a threefold higher in- fant mortality rate compared with term infants. This information is of critical importance because of its scienti ﬁ c merits and practical implications. However, it warrants a critical and balanced review, given the apparent overall uncomplicated outcome for the majority of LP infants.
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Moderate to late preterm infants (32-36 +6 weeks’ gestation) make up 83% of preterm births in New Zealand. Preterm birth is associated with having a higher risk of obesity, diabetes and cardiovascular disease in later life. Preterm infants demonstrate postnatal growth restriction followed by a period of accelerated growth. When compared to term infants at equivalent ages, preterm infants have been found to have a higher % fat mass. Nutrition is a modifiable factor contributing to the growth of preterm infants. While the goal is for these infants to be breast-fed, this is often not possible in early postnatal life due to delayed maternal milk supply and immaturity of the infant. Evidence is limited for the optimal feeding strategy for these infants until full breast-feeds can be established and there is great variability in practice. Aims:
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There are three published systematic reviews of studies evaluating the neurodevelopmental outcome of late pre- term infants [3, 5, 8]. All three reviews concluded that LPI are at increased risk of neurodevelopmental disabil- ity in comparison to their term counterparts and recom- mend closer follow up of these infants. Most of the studies were conducted in high income countries, par- ticularly the United States of America. There were no studies from sub-Saharan Africa. The aim of this study was therefore to determine the neurodevelopmental out- come of late preterm infants in Johannesburg, South Africa in comparison to a group of term control infants.
CI: Confidence interval; N-CPAP: Nasal continous positive airways pressure; CRM: Composite respiratory morbidity; CS: Cesarean section; GA: Gestational age; iNO: Inhaled nitric oxide; LPI: Late preterm infants; MAS: Meconium aspiration syndrome; MV: Mechanical ventilation; NICU: Neonatal intensive care unit; OR: Odd ratio; PPH: Persistent pulmonary hypertension; RDS: Respiratory distress syndrome; SGA: Small for gestational age; TI: Term infants; TTN: Transient tachypnea of the newborn.
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The SD and D were obtained from the results of the MOM study , which assessed the effects of relaxation meditation tape on reducing maternal stress assessed by PSS between intervention and control groups (D = 3.13, SD = 5.00). A sample of 82 mother-infant pairs (41 per randomised group) would allow the detection of a 3.13 points difference in perceived stress between groups at 80% power with a significance level of 0.05. Considering the microbiome analysis in the present study will only be conducted in vaginal delivered mothers, which account for approximately 40% of the total sample, a larger sample is required. However, the effect size in the present study may be larger than the MOM study, as mothers with pre- term infants are likely to be more stressed than mothers with healthy term infants, which were examined in the MOM study. Thus, a total of 120 infants will be recruited.
According to this hypothesis, male fetuses could be less mature than the US-based GA estimate, since the ap- proximation of GA from fetal size used during ultrasound dating would not consider size differences. In Sweden, a second trimester scan, using the biparietal diameter (BPD)-measurement for pregnancy dating, is typically per- formed around gestational week 18 at what time the mean difference (male vs. female) in BPD is considered to be 1 mm . An introduced bias in the GA estimate, due to size difference by fetal sex at the time of pregnancy dating, would be hypothesized to affect clinical management and neonatal outcomes in the late preterm and early term period. Although often treated as term, late preterm in- fants more commonly present with prematurity-related morbidity such as hyperbilirubinemia, respiratory distress syndrome (RDS) of the newborn, transient tachypnea of the newborn, interventions to support breathing, and readmissions for hospital care .
The publication of the NICHD executive summary of the workshop proceedings led to a high-impact paradigm shift in many domains. In addition to the milestones noted in Table 1, the national and international research community responded vigorously. More than 500 articles have appeared on this topic since 2007, including observational and case-controlled studies, short-term and long-term follow-up reports, comprehensive and systematic reviews, editorials, and opinion pieces. Most studies underscored the vulnerability of late preterm infants reported by the NICHD workshop panel. 1 They
High bilirubin levels are associated with sensorineural hearing loss. Exchange transfusions are recommended when bilirubin levels reach certain thresholds. However, the relative and excess risks of hearing loss in infants with bilirubin levels at/above exchange transfusion thresholds are unknown. In this Northern California population of term and late preterm infants, elevated bilirubin levels were not associated with an increased risk of sensorineural hearing loss unless the levels were at least 10 mg/dL above exchange transfusion thresholds.
whose primary language is not English may choose not to refer their child or follow through with the referral, per- haps owing to cultural beliefs and lack of perceived need. Additional strate- gies may be needed to engage these populations. Second, although we had a high linkage rate of birth certi ﬁ cates to hospital discharge and death cer- ti ﬁ cate records, 17% of EI records could not be linked to birth certi ﬁ cate records. We could not determine if nonlinked EI data were biased in re- lation to the presence or absence of certain birth characteristics because of the unavailability of birth certi ﬁ cate and birth hospital discharge in- formation on children enrolled in EI who were born out of state or were adopted. Third, like all other studies that rely on vital statistics and admin- istrative data, we were constrained to routinely collected data, and therefore, unmeasured differences may have led to residual confounding. Finally, the generalizability of this study to other states with more or less aggressive EI recruitment and eligibility and higher rates of late preterm and early term birth is unknown.
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MoBa releases updates every year; this study used the complete quality-assured MoBa dataset made available for research in 2013 (version 7). We included women who conceived spontaneously, gave birth to a singleton live- born infant, had a pre-pregnancy body mass index (BMI) from 14 to 50 , and provided valid information on anxiety on the week 17 and week 30 questionnaires. This reduced the sample to 90,083 women. We excluded women with deliveries before week 34/0 days and after week 40/6 days, women who participated with a second or third pregnancy in MoBa, and women with serious pre- pregnancy disorders (rheumatoid arthritis, kidney disease, chronic hypertension, heart disease, epilepsy, and diabetes type 1 or type 2). We also excluded women with infants who had Apgar scores less than 7 or had serious malfor- mations. After we applied all the inclusion and exclusion criteria, 81,244 pregnant women remained in the sample.
neonatal hypoglycemia and adverse neurodevelopmental outcomes at age 2 years. This study was a prospective cohort of late preterm and term infants ( ≥ 35 weeks’ gestation) at risk for hypoglycemia, defined as glucose concentration <47 mg/dL, that assessed the relation between the duration, frequency, and severity of low glucose concentrations in the neonatal period and neurodevelopmental outcomes at 2 years. They found that the lowest blood glucose concentration, number of hypoglycemic episodes, and negative interstitial increment did not predict neurodevelopmental outcome. Our finding of lower problematic behaviors in children with the most severe hypoglycemia in comparison with normoglycemic peers and less severe hypoglycemia was unexpected. Although
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states focused on policies and practices to reduce tobacco use in pregnancy and reduce nonindicated preterm delivery. 18,19 State perinatal quality collaboratives, which consisted of teams of clinical and public health members, have also helped to reduce the rates of nonmedically indicated LPT and ET births. 20 Progress has been made in the rate for triplet and higher- order–multiple births, which has been on the decline since 1998 and presently is the lowest in more than 2 decades. 3,21–23 In part from the efforts from the March of Dimes program that no infant be delivered electively before 39 weeks ’ gestation, the cesarean delivery rate is down 3% from a peak of 32.9% in 2009. 3 In a large randomized controlled trial, the beneﬁts of a single course of antenatal betamethasone was
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