Early health issues in late pre-terms


  • Monica Choudhary Department of Paediatrics, Index Medical College Hospital and Research Centre, Index City, Indore, Madhya Pradesh, India
  • Kamna Jain Department of Paediatrics, Choithram Hospital and Research Centre, Indore, Madhya Pradesh, India




Early health problems, Late preterm, Morbidity


Background: Rates of preterm birth are increasing worldwide, mostly due to late preterm births (i.e. 34-36 6/7 weeks). The objective of the study is to calculate incidence of early morbidity and mortality in late preterm neonates (within first 7 days of life) compared with term neonates.

Methods: It was a prospective cohort study. All live inborn late preterm infants (34 0/7 to 36 6/7 weeks) and term infants (37 0/7 to 41 6/7 weeks) who were born between November 2010 to October 2011. Study was done to find out early morbidity and mortality in late preterm births.

Results: Present study included 256 late preterm infants and 498 term infants, amongst whom 95 (37.10%) late preterm and 98 (19.67%) term infants required NICU care (p<0.001). Late preterm infants were at significantly higher risk for overall morbidity due to any cause (P<0.001; Odds Ratio (OR):2.4; 95% CI: 1.7-3.3), respiratory morbidity (P<0.001; OR:3.64; 95% CI:1.7-7.4), neonatal depression (p<0.001; OR:2.94; 95% CI:1.00-8.62), any resuscitation/ventilation (P<0.05; OR: 3.1; 95% CI:1.15-8.31), probable sepsis (P<0.001; OR:11.2; 95% CI:2.5-49.8), confirmed sepsis (p=0.05; OR:7.7; 95% CI:0.9-63.9), or other problems like jaundice, hypoglycemia, hypothermia and feeding difficulty. The incidence of morbidity increased as gestational age decreases from 19.67% in term infants (>37 weeks) to 27.8%, 43%, 54.5% at 36, 35 and 34 weeks, respectively (P<0.001).

Conclusions: The morbidity risk in late preterm births is 1.3 times more at 36 weeks, 2 times more at 35 weeks and 2.7 times more at 34 weeks as compared with term neonates. The mean cost of stay increased 1.8 times in the late preterm neonates as compared to the term neonates.


American Academy of Pediatrics and the American College of Obstetricians and Gynecologists. Guidelines for Perinatal Care, 5th Ed. American Academy of Pediatrics, Elk Grove Village, IL; 2005:211-220.

Raju TN, Higgins RD, Stark AR, Leveno KJ. Optimizing care and outcome for late-preterm (near-term) infants: a summary of the workshop sponsored by the NICHD. Pediatr. 2006;118:1207-14.

Engle WA. A recommendation for the definition of “late preterm” (near-term) and the birth weight-gestational age classification system. Semin Perinatol. 2006;30:2-7.

Martin JA, Park MM. Trends in twin and triplet births: 1980–97. Natl Vital Stat Rep. 1999;47(24):1-16.

Joseph KS, Allen AC, Dodds L, Vincer MJ, Armson BA. Causes and consequences of recent increases in preterm birth among twins. Obstet Gynecol. 2001;98:57-64.

Davidoff MJ, Dias T, Damus K. Changes in the gestational age distribution among U.S. singleton births: impact on rates of late preterm birth, 1992-2002. Semin Perinatol. 2006;30:8-15.

Institute of Medicine, Committee on Understanding Premature Birth and Assuring Healthy Outcomes. Preterm Birth: Causes, Consequences, and Prevention. Behrman RE, Butler AS, eds. Washington, DC: National Academies Press 2007.

Casey BM, McIntire DD, Leveno KJ. The continuing value of the Apgar score for the assessment of newborn infants. New Engl J Med. 2001;344:467-71.

Moster D, Lie RT, Irgens LM, Bjerkedal T, Markestad T. The association of Apgar score with subsequent death and cerebral palsy: A population based study in term infants. J Pediatr. 2001;138:798-803.

Verani JR, McGee L, Schrag S. Prevention of perinatal group B streptococcal disease, revised guidelines from CDC, 2010. Morbidity and Mortality Weekly Report. 59(RR-10):1-36, 2010.

Stoll BJ, Hansen NI, Sánchez PJ, Faix RG, Poindexter BB, Van Meurs KP, et al. Early onset neonatal sepsis: the burden of group B streptococcal and E. coli disease continues. Pediatr. 2011:127:817-826.

Wang ML, Dorer DJ, Fleming MP, Catlin EA. Clinical outcomes of near-term infants. Pediatr. 2004;114:372-6.

Shapiro-Mendoza CK, Tomashek KM, Kotelchuck M, Barfield W, Weiss J, Evans S. Risk factors for neonatal morbidity and mortality among “healthy” late preterm newborns. Semin Perinatol. 2006;30:54-60.

Tomashek KM, Shapiro-Mendoza CK, Weiss J. Early discharge among late preterm and term newborns and risk of neonatal mortality. Semin Perinatol. 2006;30:61-68.

Paul IM, Lehman EB, Hollenbeak CS, Maisels MJ. Preventable newborn readmissions since passage of the Newborns' and Mothers' Health Protection Act. Pediatr. 2006;118:2349-58.

Martin JA, Hamilton BE, Sutton PD, Ventura SJ, Menacker F, Munson ML. Births: final data for 2003. Natl Vital Stat Rep. 2005;54(2):1-116.

Shapiro-Mendoza CK, Tomashek KM, Kotelchuck M, Barfield W, Nannini A, Weiss J, et al. Effect of late-preterm birth and maternal medical conditions on newborn morbidity risk. Pediatr. 2008;121:e223-32.

Melamed N, Klinger G, Tenenbaum-Gavish K, Herscovici T, Linder N, Hod M, et al. Short term neonatal outcome in low risk, spontaneous, singleton, late preterm deliveries. Obstet Gynecol. 2009;114:253-60.

Escobar GJ, Clark RH, Greene JD. Short-term outcomes of infants born at 35 and 36 weeks gestation: authors need to ask more questions. Semin Perinatol. 2006;30:28-33.

Henderson-Smart DJ, Pettigrew AG, Campbell DJ. Clinical apnea and brain-stem neural function in preterm infants. NEJM. 1983;308:353-7.

Henderson-Smart DJ. The effect of gestational age on the incidence and duration of recurrent apnoea in newborn babies. Aust Paediatr J. 1981;17:273-6.

Santos IS, Matijasevich A, Silveira MF, Sclowitz IK, Barros AJ, Victora CG, et al. Associated factors and consequences of late preterm births. Paediatr Perinat Epidemiol. 2008;22(4):350-9.

Jaiswal A, Murki S, Gaddam P, Reddy A. Early Neonatal Morbidities in Late Preterm Infants. Indian Pediatr. 2010;48(8):607-11.

Lubow JM, How HY, Habli M, Maxwell R, Sibai BM. Indications for delivery and short-term neonatal outcomes in late preterm as compared with term births. Am J Obstet Gynecol. 2009;200(5):e30-3.

Reddy UM, Ko CW, Raju TN, Willinger M. Delivery indications at late-preterm gestations and infant mortality rates in the United States. Pediatr. 2009;124:234-40.

Laughon SK, Reddy UM, Sun L, Zhang J. Precursors for late preterm birth in singleton gestations. Obstet Gynecol. 2010;116:1047-55.






Original Research Articles