Even early term is too early

Even early-term neonates have high neonatal morbidity and high rates of admission to the neonatal intensive care unit (NICU) or neonatology service, compared with term infants.

Although most of us used to think that full-term neonates born between 37 and 41 weeks’ gestation were, as a whole, a low-risk group, research continues to show that tremendous variation exists within this 5-week period, and that although these babies may look healthy, those born early term (at 37 or 38 weeks) have significantly higher rates of problems than those born between 39 and 41 weeks.

In what is considered to be the first population-based countywide assessment of neonatal morbidity among early-term infants, researchers looked at almost 30,000 live full-term births reported in Erie County, New York, during the 3-year period from 2006 to 2008.

Compared with the term infants, those born at 37 or 38 weeks had twice the rate of hypoglycemia (4.9% vs 2.5%), about a 60% higher rate of admission to the NICU or neonatology service (8.8% vs 5.3%), almost twice the need for respiratory support (2% vs 1.1%), a 68% higher need for intravenous fluids (7.5% vs 4.4%), a 62% higher need for treatment with intravenous antibiotics (2.6% vs 1.6%), and 5 times the need for mechanical ventilation or intubation (0.6% vs 0.1%).

More than one-third (38.4%) of the early-term births were by cesarean delivery and the rates of problems were even higher among this group. These babies had a 12.2% increased risk for NICU or neonatology service admission and a 7.5% increased risk of morbidity, compared with term births.

An editorial accompanying the study points out that this research adds to the growing number of studies that demonstrate that maturation is a continuum, and early term infants, irrespective of mode of delivery, are at higher risk of mortality, morbidity, and learning difficulties. 

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