Moderately premature infants often ill early on

By Will Boggs, MD

NEW YORK (Reuters Health) - Infants born prematurely at 30 to 34 weeks' gestation experience significant morbidity in the early months of life, researchers report

"Near-term babies are at high risk for adverse outcomes," Dr. Gabriel J. Escobar from Kaiser Permanente Medical Care Program, Oakland, California told Reuters Health.

Escobar and colleagues evaluated birth outcomes and 3-month follow-up of 850 30- to 34-week infants who survived the birth stay in the hospital -- a group they dub "unstudied infants," since much of the recent neonatal literature has focused on more premature infants.

They report in the Archives of Disease in Childhood, Fetal and Neonatal Edition that almost half the babies required some form of assisted ventilation to help them breathe and about a quarter of the infants received surfactant, substance that helps the lungs expand.

Among the 30-32 week infants, the results indicate, 4.9 percent developed sepsis or meningitis, 1.2 percent developed inflammation of the intestines, a condition known as necrotizing enterocolitis, and 0.6 percent developed bleeding in the brain.

These rates are all substantially higher than those reported for term infants, the investigators explain.

Just over 11 percent of the infants required readmission to the hospital within 3 months of being discharged, the researchers note. This compares with a readmission rate of only 4.3 percent for term infants in the Kaiser Permanente Medical Care Program in 2002.

Escobar recommends "greater attention to initial management in the neonatal period; in particular, these babies should not be a) treated on the basis of their birth weight; b) rushed out of the hospital; and c) evaluated unaggressively when they show temperature instability, poor feeding, or respiratory distress."

"We need more research on these babies to decide what works and what does not," Escobar concluded. "Working with a team of investigators from the March of Dimes, we are going to look at Kaiser Permanente data to ascertain developmental outcomes among near-term infants."

SOURCE: Archives of Disease in Childhood, Fetal and Neonatal Edition, July 2006.