31.10.18 Early Neonatal Morbidities in Late Preterm Neonates

Original Article

 

Neonatal Morbidities

Early Neonatal Morbidities in Late Preterm Neonates

Nasir Khan1, Khyal Muhammad2, Fiaz Ahmed3, Zaheer Abbas2, Rifayat Ullah Afridi4 and Ejaz Hussain2

ABSTRACT

Objective: To determine the distribution of early neonatal morbidities in late preterm infants.

Study Design: Descriptive study

Place and Duration of Study: This study was conducted at the department of Pediatrics and Neonatology Ayub teaching hospital, Abbottabad from May 2018 to December 2019.

Materials and Methods: After taking approval from ethical committee, data was collected from all neonates admitted to department of neonatology, who were born late preterm with gestation of less than 37 weeks but with 34 completed weeks. Total 147 neonates were included in this study. In all neonates who were included in this study, morbidities were evaluated from birth till 7th day of life through clinical examination and relevant investigations and were recorded on proforma.

Results: Mean neonatal age was 4 days with SD ± 3.74. Fifty-six percent neonates were male and 44% neonates were female. More over 25% neonates had hyperbilirubinemia, 28% neonates had sepsis, 20% neonates had intrauterine growth restriction, 4% neonates had transient tachypnea of newborn, 15% neonates had hypoglycemia, 16% neonates had respiratory distress syndromes and 13% neonates had apnea.

Conclusion: Our study concludes neonatal morbidities like hyperbilirubinemia, sepsis, intrauterine growth restriction, transient tachypnea of newborn; hypoglycemia, respiratory distress syndromes, and apnea are associated with late preterm births.

Key Words: Early neonatal morbidities, late preterm, infants

Citation of article: Khan N, Muhammad K, Ahmed F, Abbas Z, Afridi RU, Hussain E. Early Neonatal Morbidities in Late Preterm Neonates. Med Forum 2020;31(10):75-78.

 

 

INTRODUCTION

Preterm delivery  is  one of the  most significant cause of neonatal morbidity and  mortality.1 Globally  preterm deliveries are occurring due to various medical and obstetrical conditions mostly occurring in the late preterm period that results in morbidities of the new born.2 Late preterm neonates, born with period of gestation less than 37 weeks but 34 completed weeks are considered normal newborns and are kept in well-infant nursery units under the similar protocols as that of the term infants and sent home before sufficient observational period.3,4 Late preterm babies are not physiologically as full-grown as term babies so should not be considered functionally term in any aspect.5

 

 

1. Women Medical College Abbottabad.

2. Ayub Teaching Hospital Abbottabad.

3. Women & Children Hospital

4. Department of Pediatrics, Nasseer Teaching Hospital, Peshawar.

 

 

Correspondence: Dr. Nasir Khan, Assistant Professor Women Medical College, Abbottabad.

Contact No: 0311-5529571

Email: drnasirkhan1234@gmail.com

 

 

Received:    April, 2020

Accepted:    July, 2020

Printed:        October, 2020

 

 

 

Late preterm infants are at high threat of morbidity and endangered outcome.6 These babies are at notably high short and long term unfavorable outcomes compare to term babies with a list of neonatal problems documented in literature.2   Some of these problems include feeding difficulties, hypoglycemia, respiratory distress syndromes (RDS), intrauterine growth retardation, sepsis, apnea, jaundice (hyperbiliru-binemia) and transient tachypnea of the newborn.7-10

In a study in Pakistan by Haroon et al.11 the Respiratory distress syndrome was documented as 16.5%, High level of bilirubin of 37.9%, Hypoglycemia was reported about 5.2%, Growth retardation was 24.8%, Sepsis was documented about 4.9%, Transient tachypnea of newborn was reported in 7.0%, Apnea was documented about 15.3 in a Pakistani.

As the late preterm group is associated with greater morbidity compare to term neonates so this study is undertaken to identify the early neonatal morbidities in later preterm babies. Prior awareness of the morbidities associated with late preterm bodies is helpful for the health care provides to anticipate and manage potential complications in late preterm infants. Accurate estimate of the risks of morbidities is required to enable healthcare provider to take timely measures to improve the outcome.

 

MATERIALS AND METHODS

After taking hospital ethics committee approval this descriptive study was conducted at Pediatric Department, Ayub Teaching Hospital Abbottabad from May 2018 to December 2019. Sample size of 147 was calculated using previous study.11 Sampling technique applied was Consecutive non-probability sampling. All the late preterm (34 to 36 weeks of gestation) infants of both genders and of age up to 7 days admitted to neonatology unit of Ayub Teaching Hospital, Abbottabad were included while the term infants, infants with congenital anomies, syndromes, early preterm, multiple births and surgical conditions were excluded. Pretest counseling was given to parents. After written consent from the parents, those neonates fulfilling the above mentioned criteria were assessed for gestational age by menstrual period. In every baby who had require admission to neonates unit from birth to first 7 days of life, morbidities such as respiratory distress syndrome, hypoglycemia, sepsis, transient high respiratory rate of newborn, apnea and jaundice were evaluated. Infants were evaluated daily till 7 days of life through clinical examination or investigation for development of any of the morbidities mentioned above.  Any of the predefined medical conditions resulting in post-delivery inpatient hospital observation and admission were assessed by physical examination as well as through relevant investigations. All the observations were done under supervision of an experience pediatrician.

All the above mentioned information including name, age, gender and address were recorded on a pre-designed proforma.

Data was analyzed using SPSS version 21. Quantitative variables like age, gestation (weeks), weight were described

in terms   of means+ standard   deviation.   Categorical data   like   gender and early   neonatal morbidities (hyperbilirubinemia, sepsis, intrauterine growth restriction, transient tachypnea of newborn, hypoglycemia, respiratory distress syndrome and apnea) were described in the terms of frequency and percentages. All results were presented as tables and diagrams. Data was stratified by gender, age, gestation (weeks) & weight in term of neonatal morbidities. Post stratification chi -square test was used at 5% level of significance.

RESULTS

Table No 1. Neonatal morbidity (n= 147)

Morbidity

Frequency

Percentage

Hyperbilirubinemia

37

25%

Sepsis

41

28%

Intrauterine growth Restriction

29

20%

Transient tachypnea of Newborn

6

4%

Hypoglycemia

22

15%

Respiratory distress Syndrome

24

16%

Apnea

19

13%

Table No 2. Stratification of neonatal morbidity w.r.t age distribution

Morbidity

Status

1-4 days

4-7 days

Total

P value

Hyperbili-rubinemia

Yes

26

11

37

 

0.8127

No

75

35

110

Total

 

101

46

147

 

Sepsis

Yes

28

13

41

 

0.9462

No

73

33

106

Total

 

101

46

147

 

Intrauterine growth restriction

Yes

20

9

29

 

0.9733

No

81

37

118

Total

 

101

46

147

 

Transient tachypnea of newborn

Yes

4

2

6

 

0.9123

No

97

44

141

Total

 

101

46

147

 

Hypoglycemia

Yes

15

7

22

 

0.9540

No

86

39

125

Total

 

101

46

147

 

Respiratory distress syndrome

Yes

17

7

24

 

0.8060

No

84

39

123

Total

 

101

46

147

 

Apnea

Yes

13

6

19

 

0.9770

No

88

40

128

Total

 

101

46

147

 

Table No. 3: Stratification of neonatal morbidity w.r.t. gender distribution

Morbidity

Status

Male

Female

Total

P value

Hyperbilirubinemia

Yes

21

16

37

 

0.8903

No

61

49

110

Total

 

82

65

147

 

Sepsis

Yes

23

18

41

 

0.9618

No

59

47

106

Total

 

82

65

147

 

Intrauterine growth restriction

Yes

16

13

29

 

0.9412

No

66

52

118

Total

 

82

65

147

 

Transient tachypnea of newborn

Yes

3

3

6

 

0.7709

No

79

62

141

Total

 

82

65

147

 

Hypoglycemia

Yes

12

10

22

 

0.8992

No

70

55

125

Total

 

82

65

147

 

Respiratory distress syndrome

Yes

13

11

24

 

0.8617

No

69

54

123

Total

 

82

65

147

 

Apnea

Yes

11

8

19

 

0.8425

No

71

57

128

Total

 

82

65

147

 

In this study age distribution among 147 neonates was analyzed as 101(69%) neonates were in age range 1-4 days, 46(31%) neonates were in age range 4-7 days. Mean age was 4 days with SD ± 3.74 Gender distribution among 147 neonates was analyzed as 82(56%) neonates were male and 65(44%) neonates were female. Gestational weeks among 147 neonates were analyzed as 56(38%) neonates had 35 weeks of gestation while 91(62%) neonates had 36 weeks of gestation. Mean Gestational weeks was 36 weeks with SD ± 2.341 Weight distribution among 147 neonates was analyzed as 26(18%) neonates had weight <1.5 kg while 106(72%) neonates had weight range 1.5-2.5 Kg. Mean weight was 1.7 kg with SD ± 1.116.

Table No. 4: Stratification of neonatal morbidity w.r.t gestational week

Morbidity

Status

35 weeks

36 weeks

Total

P value

Hyperbilirubinemia

Yes

14

23

37

0.9703

 

No

42

68

110

 

Total

 

56

91

147

 

Sepsis

Yes

16

25

41

 

0.8853

No

40

66

106

Total

 

56

91

147

 

Intrauterine growth restriction

Yes

11

18

29

 

0.9838

No

45

73

118

Total

 

56

91

147

 

Transient tachypnea of newborn

Yes

2

4

6

 

0.8063

No

54

87

141

Total

 

56

91

147

 

Hypoglycemia

Yes

8

14

22

 

0.8561

No

48

77

125

Total

 

56

91

147

 

Respiratory distress syndrome

Yes

9

15

24

 

0.9477

No

47

76

123

Total

 

56

91

147

 

Apnea

Yes

7

12

19

 

0.9041

No

49

79

128

Total

 

56

91

147

 

Table No. 5. Stratification of neonatal morbidity w.r.t weight

Morbidity

Status

35 weeks

36 weeks

Total

P value

Hyperbili-rubinemia

Yes

14

23

37

0.9703

 

No

42

68

110

 

Total

 

56

91

147

 

Sepsis

Yes

16

25

41

 

0.8853

No

40

66

106

Total

 

56

91

147

 

Intrauterine growth restriction

Yes

11

18

29

 

0.9838

No

45

73

118

Total

 

56

91

147

 

Transient tachypnea of newborn

Yes

2

4

6

 

0.8063

No

54

87

141

Total

 

56

91

147

 

Hypoglycemia

Yes

8

14

22

 

0.8561

No

48

77

125

Total

 

56

91

147

 

Respiratory distress syndrome

Yes

9

15

24

 

0.9477

No

47

76

123

Total

 

56

91

147

 

Apnea

Yes

7

12

19

 

0.9041

No

49

79

128

Total

 

56

91

147

 

 

Neonatal morbidity among 147 neonates was analyzed as 37(25%) neonates had hyperbilirubinemia, 41(28%) neonates had sepsis, 29(20%) neonates had intrauterine growth restriction, 6(4%) neonates had transient tachypnea of newborn, 22(15%) neonates had hypoglycemia, and 24 (16%) neonates had respiratory distress syndromes while 19 (13%) neonates had Apnea. (Table 1).

DISCUSSION

There has been a concomitant rise in the rate of morbidities among newborn delivered as preterm gestation.6

Our study showed that among 147 neonates 69% neonates were in age range 1-4 days, 31% neonates were in age range 4-7 days. Mean neonatal age was 4 days with SD±3.74. Fifty six percent neonates were male and 44% neonates were female. Thirty eight percent neonates had 35 weeks of gestation while 62% neonates had 36 weeks of gestation. Mean Gestational weeks was 36 weeks with SD ± 2.341. Eighteen percent neonates had weight <1.5 kg while 106(72%) neonates had weight range 1.5-2.5 Kg. Mean weight was 1.7 kg with SD ± 1.116. More over 25% neonates had hyperbilirubinemia, 28% neonates had sepsis, 20% neonates had intrauterine growth restriction, 4% neonates had transient tachypnea of newborn, 15% neonates had hypoglycemia, and 16% neonates had respiratory distress syndromes while 13% neonates had Apnea.

Similar results were observed in a study conducted by Haroon A et al11 in which Respiratory distress syndrome in

16.5%, Growth retardation in 24.8%, high level of bilirubin in 37.9%, sepsis was 4.9%, hypoglycemia in 5.2%, transient high respiratory rate in 7.0% and apnea in 15.3%.

In another study conducted by Femitha P et al12 in which respiratory distress syndrome was 12.4%, hyperbilirubinemia was 28.7%, sepsis was 20.8%, and Hypoglycemia was 5.2%. while in a study at Brazil13  the growth retardation was 26.1%, transient tachypnoea was 25.9% and apnoea was 6.3% while 30% sepsis, hypoglycemia in 10.3% and feeding difficulty in 15.8% late preterm neonates were recorded in Jordan.14

Tiwari et al15 reported that among late preterm 13.06% developed respiratory distress 52.56% late preterm had jaundice, 10.99% episodes of hypoglycemia, Hypothermia occurred in 7.94% late preterm neonates, 4.24% late preterm experienced one or more episodes of apnea. 18.06% late preterm babies had feeding problems, 9.79% term babies had confirmed sepsis.

In a study conducted by Binarbasi P et al16, hypothermia was noted in 14.5% of late preterm neonates and feeding difficulty in 19.1% in late preterm. Ligginc GC et al17 observed that incidence of apnea in 6% late preterm babies. In another study18 the incidence of sepsis in late preterm was 10.3%.

This variation may be due to climatic condition of study places, difference in cut off temperature for consideration of hypothermia or differences in timing of study.

CONCLUSION

Our study concludes that the frequency of early neonatal morbidities like hyperbilirubinemia, sepsis, intrauterine growth restriction, transient tachypnea of newborn, hypoglycemia, respiratory distress syndromes, apnea are associated in late preterm infants. Prior awareness of the morbidities associated with late preterm bodies is helpful for the health care provides to anticipate and manage potential complications in late preterm infants. Accurate estimate of the risks of morbidities is required to enable healthcare provider to take timely measures to improve the outcome.

Author’s Contribution:

Concept & Design of Study:

Nasir Khan

Drafting:

Khyal Muhammad,
Fiaz Ahmed

Data Analysis:

Zaheer Abbas, Rifayat Ullah Afridi, Ejaz Hussain

Revisiting Critically:

Nasir Khan, Khyal Muhammad

Final Approval of version:

Nasir Khan

Conflict of Interest: The study has no conflict of interest to declare by any author.

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