Late preterm births and associated neonatal outcomes in a tertiary care center-A prospective observational study.

Background: Prematurity is one of the leading causes of morbidity and mortality among newborns. The incidence of preterm deliveries especially the late preterm births have unfortunately gone up in the last decade. Late preterm births are associated with increased neonatal complications compared to term births. This study makes an effort to find out the relevant maternal and fetal factors associated with late preterm births. This study also assesses the maternal and neonatal outcomes associated with late preterm births. Methods: This prospective observational study was conducted at Maternal and Child Health Unit of Shri B M Patil Medical College Hospital Vijayapur, Karnataka over a period of 1 year. 200 late preterm births and 200 term births were enrolled in the study. During the study period, all neonates delivered in the hospital were divided into two groups as late preterm group and term group. Maternal and neonatal data was collected in predefined structured proforma. Results: The mother's mean age in the late preterm group was 24.34 ± 4.07 years, and among the term group was 25.24 ± 4.54 years, which was not statistically significant (P=0.857). The obstetric risk factors observed for late preterm births were inadequate antenatal care (39%), premature rupture of membranes (31%), hypertensive disease of pregnancy (24.5%), previous preterm delivery (21%), and maternal anemia (13%). When two or more factors were found, late preterm labor incidence was 32.6% in this study. 14.5% late preterm's needed resuscitation (P=0.003), 45% late preterm neonates had difficulty establishing feeding at birth (P<0.001), 34% late preterm’s had respiratory distress at birth (P<0.001), 12% had hypoxic-ischemic encephalopathy (Stage2/3) (0.003), 35% had early-onset sepsis (P<0.001), 28% had jaundice (P<0.001), 24% had hypoglycemia (P<0.001), 41% had hypothermia (P<0.001), 13.5% had HSPDA (P<0.006). The duration of hospital stay was significantly more in late preterm neonates (8.7 ± 1.6 days) as compared to term neonates (3.9 ± 1.1 days) with a pvalue of <0.05. Most important is the mortality, which was significantly more among late preterm neonates (18%) than term neonates (6%) with a p-value of 0.011. Conclusion: Maternal risk factors such as preterm premature rupture of membrane, inadequate antenatal care, hypertensive disorders of pregnancy, and maternal anemia were associated with late preterm births. Since late preterm birth is an independent risk factor for neonatal morbidity and mortality compared to term neonates, knowing maternal and perinatal risk factors is essential. Early identification and management of these risk factors reduces the neonatal morbidities and mortalities.