Late-preterm infants, early-term infants, and timing of elective deliveries; current status in a Korean medical center

Early-Term Neonates Demonstrate a Higher Likelihood of Requiring Phototherapy Compared to Those Born Full-Term

Early-term neonates (with a gestational age (GA) of 37 and 0/7 weeks to 38 and 6/7 weeks) face higher morbidities, including respiratory and neurodevelopmental issues, than full-term (39 and 0/7 weeks to 40 and 6/7 weeks) infants. This study explores whether hyperbilirubinemia necessitating phototherapy also differs between these groups. A retrospective study was conducted on neonates born from January 2021-June 2022, excluding those with specific conditions. Evaluated factors included GA, birth weight, bilirubin levels, glucose-6-phosphate dehydrogenase (G6PD) deficiency, and feeding type, with phototherapy given as per AAP guidelines. Of 1085 neonates, 356 met the criteria. When stratifying the neonates based on the need for phototherapy, a higher proportion of early-term neonates required phototherapy compared to full-term (p < 0.05). After factoring in various risks (GA; birth weight; gender; feeding type; G6PD deficiency; transcutaneous bilirubin levels at 24 h and 24-48 h postpartum; maternal diabetes; and the presence of caput succedaneum or cephalohematoma), early-term neonates were more likely to need phototherapy than full-term babies (OR: 2.15, 95% CI: 1.21 to 3.80). The optimal cut-off for transcutaneous bilirubin levels 24-48 h postpartum that were used to predict phototherapy need was 9.85 mg/dl. In conclusion, early-term neonates are at a greater risk for developing jaundice and requiring phototherapy than full-term neonates. Monitoring bilirubin 24-48 h postpartum enhances early prediction and intervention.

Expectant management of preterm premature rupture of membranes at 34 weeks: a cost effectiveness analysis

OBJECTIVE

To examine the outcomes and cost effectiveness of expectant management versus immediate delivery of women who experience preterm premature rupture of membranes (PPROM) at 34 weeks.

METHODS

A cost-effectiveness model was built using TreeAge software to compare outcomes in a theoretical cohort of 37,455 women with PPROM at 34 weeks undergoing expectant management until 37 weeks versus immediate delivery. Outcomes included fetal death, neonatal sepsis, neonatal death, neonatal neurodevelopmental delay, healthy neonate, maternal sepsis, maternal death, cost, and quality-adjusted life years. Probabilities were derived from the literature, and a cost-effectiveness threshold was set at $100,000 per quality-adjusted life year.

RESULTS

In our theoretical cohort of 37,455 women, expectant management yielded 58 fewer neonatal deaths and 164 fewer cases of neonatal neurodevelopmental delay. However, it resulted in 407 more cases of neonatal sepsis and 2.7 more cases of maternal sepsis. Expectant management resulted in 3,531 more quality-adjusted life years and a cost savings of $71.9 million per year, making it a dominant strategy. Univariate sensitivity analysis demonstrated expectant management was cost effective until the weekly cost of antepartum admission exceeded $17,536 (baseline estimate: $12,520) or the risk of maternal sepsis following intraamniotic infection exceeded 20%.

CONCLUSION

Our model demonstrated that expectant management of PPROM at 34 weeks yielded better outcomes on balance at a lower cost than immediate delivery. This analysis is important and timely in light of recent studies suggesting improved neonatal outcomes with expectant management. However, individual risks and preferences must be considered in making this clinical decision as expectant management may increase the risk of adverse perinatal outcomes when the risk of puerperal infection increases.

The assessment of phagocytic and bactericidal activity of platelets and plasma bactericidal activity in late preterm newborns*

Background

The aim of the study was to compare the phagocytic and bactericidal properties of blood platelets and the plasma bactericidal activity in 66 late preterm (LPN) and 74 full-term newborns (FTN).

Materials/Methods

Blood samples were collected from the umbilical artery. Bacteria of the Staphylococcus aureus ATCC 6538P were used for the tests.

Results

Platelet counts in LPN vs FTN were the following: 225 vs 258.5 (×103/μL), p = 0.003. The percentage of phagocytic platelets was the following: Me = 1.1 in LTN vs Me = 1.1 in FTN. The phagocytic index was the following: Me = 1 for both LPN and FTN. The phagocytic properties of platelets increased as the birth weight increased. The bactericidal activity of platelets was the following: Me = 0; (average = 0.7) in LPN vs Me = 0; (average = 0.8) in FTN. The median plasma bactericidal activity in LPN was 41.6 vs 43.8, in FTN, p = 0.027. The bactericidal capacity of plasma increased with increasing fetal age and birth weight of newborns. sP-selectin was: 63.9 ng/ml in LPN vs 71 ng/ml in FTN, p = 0.026. IL-6 in LPN was 3.6 vs 3.9 (pg/ml) in FTN, p = 0.02.

Conclusion

Late preterm newborns have lower defensive capacity against infection than full-term newborns, due to lower platelets count, lower plasma bactericidal activity and lower sP-selectin concentration, which cooperates with neutrophils, monocytes in fighting against infection. All newborns had similar phagocytic and bactericidal properties of platelets.