Dataset Information

Perinatal predictors of clinical instability at birth in late-preterm and term infants.

ABSTRACT: To identify characteristics associated with delivery room clinical instability in at-risk infants. Prospective cohort study. Two perinatal centres in Melbourne, Australia. Infants born at ≥ 35⁺⁰ weeks' gestation with a first-line paediatric doctor requested to attend. Clinical instability defined as any one of heart rate < 100 beats per minute for ≥ 20 s in the first 10 min after birth, maximum fraction of inspired oxygen of ≥ 0.70 in the first 10 min after birth, 5-min Apgar score of < 7, intubated in the delivery room or admitted to the neonatal unit for respiratory support. Four hundred and seventy-three infants were included. The median (IQR) gestational age at birth was 39⁺⁴ (38⁺⁴-40⁺⁴) weeks. Eighty (17%) infants met the criteria for clinical instability. Independent risk factors for clinical instability were labour without oxytocin administration, presence of a medical pregnancy complication, difficult extraction at birth and unplanned caesarean section in labour. Decision tree analysis determined that infants at highest risk were those whose mothers did not receive oxytocin during labour (25% risk). Infants at lowest risk were those whose mothers received oxytocin during labour and did not have a medical pregnancy complication (7% risk).

Conclusions

We identified characteristics associated with clinical instability that may be useful in alerting less experienced clinicians to call for senior assistance early. The decision trees provide intuitive visual aids but require prospective validation.

What is known

• First-line clinicians attending at-risk births may need to call senior colleagues for assistance depending on the infant's condition. • Delays in effectively supporting a compromised infant at birth is an important cause of neonatal morbidity and infant-mother separation.

What is new

• This study identifies risk factors for delivery room clinical instability in at-risk infants born at ≥ 35⁺⁰ weeks' gestation. • The decision trees presented provide intuitive visual tools to aid in determining the need for senior paediatric presence.

SUBMITTER: Santomartino GA

PROVIDER: S-EPMC10023598 | biostudies-literature | 2023 Mar

REPOSITORIES: biostudies-literature

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Publications

Perinatal predictors of clinical instability at birth in late-preterm and term infants.

Santomartino Georgia A GA Blank Douglas A DA Heng Alissa A Woodward Anthony A Kane Stefan C SC Thio Marta M Polglase Graeme R GR Hooper Stuart B SB Davis Peter G PG Badurdeen Shiraz S

European journal of pediatrics 20221123 3

To identify characteristics associated with delivery room clinical instability in at-risk infants. Prospective cohort study. Two perinatal centres in Melbourne, Australia. Infants born at ≥ 35<sup>+0</sup> weeks' gestation with a first-line paediatric doctor requested to attend. Clinical instability defined as any one of heart rate < 100 beats per minute for ≥ 20 s in the first 10 min after birth, maximum fraction of inspired oxygen of ≥ 0.70 in the first 10 min after birth, 5-min Apgar score of ...[more]

PMID: 36418782

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Project description:BackgroundThe trajectories of late preterm development from infancy to kindergarten reading and math, and predictors of academic resilience and risk are unknown.MethodsSample included 1200 late preterm infants (LPIs) from the Early Childhood Longitudinal Study, Birth Cohort. Objective measurements of development at 9 and 24 months (Bayley-SFR) and reading and math academic achievement at preschool and kindergarten were standardized; trajectories of late preterm development from 9 months to kindergarten reading and math were identified using latent class growth analysis. Multinomial logistic regression [aOR, 95% CI] identified predictors of academic resilience and risk.ResultsFour trajectory groups were observed for reading and three for math. More optimal trajectories (in reading and math) and academic resilience were associated with experiencing sensitive parenting and preschool attendance. Suboptimal (at-risk) trajectories (in reading or math) and an increased odds of academic risk were associated with <high school education, twin/multiple gestation, prenatal smoking and male sex.ConclusionsLPI trajectories varied from infancy to kindergarten. More sensitive parenting and preschool attendance predicted academic resilience, and should be encouraged. Select risk factors (prenatal smoking, twin/multiple gestation, male sex, <high school education) predicted academic risk, and can help identify LPIs who might benefit from closer monitoring prior to school entry.ImpactLate preterm infants (LPIs) have developmental risks compared to full terms. LPI trajectories of early reading and math varied from infancy to kindergarten. We identified predictors of academic resilience and risk, which can help inform anticipatory guidance provided to LPIs prior to kindergarten. Promotive factors (sensitive parenting and preschool enrollment) predicted academic resilience. Select maternal and neonatal characteristics (<high school education, male sex, prenatal smoking, and multiple gestation) predicted academic risk at kindergarten. LPIs account for the majority of preterm infants. Encouraging preschool enrollment and fostering sensitive parenting may promote early academic achievement in LPIs, which has population-level impacts.

Dataset Information

Perinatal predictors of clinical instability at birth in late-preterm and term infants.

Conclusions

What is known

What is new

Publications

Perinatal predictors of clinical instability at birth in late-preterm and term infants.

Similar Datasets

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