Late preterm infant: Late preterm infant: Is it a trend or a Is it a trend or a catastrophe? catastrophe? Michael E. Speer, MD Michael E. Speer, MD Professor of Pediatrics & Medical Professor of Pediatrics & Medical Ethics Ethics Baylor College of Medicine Baylor College of Medicine
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Late preterm infant: Is it a trend or a catastrophe? Michael E. Speer, MD Professor of Pediatrics & Medical Ethics Baylor College of Medicine.
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Late preterm infant: Is Late preterm infant: Is it a trend or a it a trend or a catastrophe?catastrophe?
Michael E. Speer, MDMichael E. Speer, MDProfessor of Pediatrics & Medical EthicsProfessor of Pediatrics & Medical Ethics
Baylor College of MedicineBaylor College of Medicine
Survival of extremely low-birth-Survival of extremely low-birth-weight infants (birth weight < 1000 weight infants (birth weight < 1000 g) increased 35% between the g) increased 35% between the 1980s and the 1990s1980s and the 1990s– 85% of infants with very low birth 85% of infants with very low birth
weight (between 500 and 1500 grams) weight (between 500 and 1500 grams) survivesurvive
Increased MorbidityIncreased Morbidity Disabilities have also increased between 1980s & Disabilities have also increased between 1980s &
1990s1990s– Primarily chronic lung disease and neuro-developmental Primarily chronic lung disease and neuro-developmental
impairmentimpairment Sepsis: Sepsis: 37% to 51% 37% to 51% Periventricular leukomalacia: Periventricular leukomalacia: 2% to 7% 2% to 7% CLD: (OCLD: (O22 at 36 wks PMA): at 36 wks PMA): 32% to 43%32% to 43% Cerebral palsy: Cerebral palsy: 16% to 25% 16% to 25% Deafness Deafness 3% to 7%3% to 7% Neurodevelopment impairment* Neurodevelopment impairment* 26% to 36% 26% to 36%
(*major neurosensory abnormality and/or Bayley Mental Developmental Index (*major neurosensory abnormality and/or Bayley Mental Developmental Index score of <70)score of <70)
Rising Rate of Rising Rate of PrematurityPrematurity
The preterm birth rate has The preterm birth rate has increased by 36% since the increased by 36% since the 1980s1980s**– > 540,000 each year at present> 540,000 each year at present– 21% increase since 1990 (10.6% to 21% increase since 1990 (10.6% to
12.8%) 12.8%) Primarily 34 to 36 weeks Primarily 34 to 36 weeks
gestation gestation – Increase of 25% since 1990 Increase of 25% since 1990
*NCHS 2006 final natality data;*NCHS 2006 final natality data; March of March of Dimes, 2009Dimes, 2009
Trends in Late Preterm Birth, Stillbirth, and Infant Mortality: US 1990-2004
Ananth CV, et al. Am J Obste Gynecol. 2008;199:329-31
Preterm Birth in the Preterm Birth in the United States: 1996 - United States: 1996 -
Source: National Center for Health Statistics Prepared by March of Dimes, Periantal Data Center, 2009
Percent of live births
>70% Late Preterm
Courtesy of Karla Damus
RISE IN LATE PRETERM BIRTHS RISE IN LATE PRETERM BIRTHS (34-36 wks)(34-36 wks)
Percentage of Births by Percentage of Births by Cesarean: 32% (2007)Cesarean: 32% (2007)
Births by caesarean section by country (2000)# 1 Italy: 333 live births per 1,000 (33.3%)# 2 Australia: 217 live births per 1,000 (21.7%)# 3 USA: 211 live births per 1,000 (21.1%)# 4 Germany: 209 live births per 1,000 (20.9%)# 5 Canada: 205 live births per 1,000 (20.5%)# 6 Ireland: 204 live births per 1,000 (20.4%)# 7 New Zealand: 202 live births per 1,000 (20.2%)# 8 Austria: 172 live births per 1,000 (17.2%)# 9 France: 171 live births per 1,000 (17.1%)# 10 United Kingdom: 170 live births per 1,000 (17.0%)# 11 Belgium: 159 live births per 1,000 (15.9%)# 12 Finland: 157 live births per 1,000 (15.7%)# 13 Denmark: 145 live births per 1,000 (14.5%)# 14 Sweden: 144 live births per 1,000 (14.4%)# 15 Norway: 137 live births per 1,000 (13.7%)# 16 Netherlands: 129 live births per 1,000 (12.9%)
Weighted average: 185.3 live births per 1,000 (18.5%)
Cesarean Section Rates – Latin America (2005)
Median rate 33% (quartile range 24–43)
Elective 49%
Intrapartum 46%
Emerg. s Labour5%
Lancet. 2006;367:1819-29
World Wide Cesarean Section Rates - WHO Asia – 27.3% (2007 – 2008)*
– China 46.2%– Sri Lanka 30.6% – Viet Nam 35.6%– Thailand 34.1%
Latin America – 35% (2005)– Brazil 36% (2009)
Private clinic rate: >90%
– Ecuador 40% (2005)– Paraguay 42% (2005)
*Lancet. 2010;375:Pages 490-499
Rates are not necessarily current http://blog.fortiusone.com/2009/04/22/birth-in-the-usa/
Risk of Placenta Accreta and Risk of Placenta Accreta and Hysterectomy by Number of Cesarean Hysterectomy by Number of Cesarean Deliveries Compared with the First Deliveries Compared with the First Cesarean DeliveryCesarean DeliveryCesarean Cesarean SectionSection
Accreta Accreta [n(%)][n(%)]
Odds RatioOdds Ratio Hysterectomy Hysterectomy [n(%]) [n(%])
Exaggerated physiologic jaundiceExaggerated physiologic jaundice DehydrationDehydration HypernatremiaHypernatremia Increased need for parenteral nutritionIncreased need for parenteral nutrition Failure to thriveFailure to thrive
demonstrated in healthy premature demonstrated in healthy premature infants (infants (36 wk GA) compared with 36 wk GA) compared with infants born at term:infants born at term: 6–10 weeks after birth6–10 weeks after birth: : FEF in healthy FEF in healthy
30–34 wk GA infants (30–34 wk GA infants (PP<0.001)<0.001)11
At age 1At age 1: : V VmaxmaxFRC in healthy 29–36 wk FRC in healthy 29–36 wk GA infants (GA infants (PP<0.05)<0.05)22
1.1. Friedrich L, et al.Friedrich L, et al. Am J Resp Crit Care Med. 2006;173:442-447. 22.2. Hoo A-F, et al.Hoo A-F, et al. J Pediatr. J Pediatr. 2002;141:652-658.2002;141:652-658.