ABSTRACT
Objective@#To investigate the clinical characteristics of early term and full term neonates, and analyze the risk factors associated with short term outcomes in early term neonates.@*Method@#Neonates with birth weight (BW) ≥2 500 g from year 2013 were analyzed retrospectively based on American Congress of Obstericians & Gynecologists (ACOG) latest definition of term infants. According to inclusion and exclusion criteria, early term (gestational age 37-38 weeks) and full term(gestational age 39-40 weeks) neonates were included, whose morbidity constituent proportion was analyzed by χ2 test or Fisher accuracy test or t test or Wilcoxon test. Risk factors associated with short term outcomes in early term population were analyzed by Logistic regression analysis.@*Result@#There were 3 002 discharged term infants being investigated, among whom 1 303 cases were included(768 males and 535 females), and 37, 38, 39 and 40 weeks′ gestational age newborns were 160, 324, 450 and 369 respectively. Compared with full term neonates(n=819), early term neonates (n=484) had longer length of hospital stay (LOS)(6.0(5.0, 9.0) vs. 6.0(4.0, 8.0), Z=2.830, P=0.005), higher usage rate of intravenous antibiotics(86.4%(418/484) vs. 80.1%(656/819), χ2=8.009, P=0.005), higher assisted ventilation rate(9.5%(46/484) vs. 2.9%(24/819), χ2=25.528, P<0.01), higher pulmonary surfactant administration rate(4.3%(21/484) vs. 1.1%(9/819), χ2=14.006, P<0.01), as well as higher hypoglycemia incidence(3.9%(19/484) vs. 1.2%(10/819), χ2=10.226, P=0.001). There were no statistically significant differences in 1 min Apgar score (9(9, 10)vs. 9(9, 10), Z=0.860, P=0.390), 5 min Apgar score (10(9, 10) vs. 10(9, 10), Z=0.810, P=0.418), white blood cell count (15 (11, 21) ×109 /L vs.15 (11, 22) ×109 /L, Z=0.880, P=0.379), hemoglobin count(180 (159, 205) vs. 182 (160, 204) g/L, Z=0.560, P=0.576), or platelet count(303(234, 372) ×109/L vs. 301(237, 391) ×109/L, Z=0.550, P=0.584). BW between 2 500 g and 2 999 g(OR 1.69, 95% CI: 1.10-2.62, χ2 =5.614, P=0.018), wet lung(OR=2.61, 95% CI: 1.61-4.24, χ2=15.023, P=0.000)and pneumonia(OR 1.88, 95% CI: 1.14-3.08, χ2=6.192, P=0.013) were risk factors in early term neonates′ short term adverse outcomes.@*Conclusion@#Early term newborns are still at their "immature" state, and respiratory disorders are major risk factors associated with short term outcomes. Hence, early delivery during 37-38 weeks should be avoided as possible as we can.
ABSTRACT
During the fetal-neonatal transition, the body must undergo many important physiological changes to adapt the extrauterine environment. After birth, the blood and energy supply through placenta is stopped with clamping of the umbilical cord and, meanwhile, the pulmonary ventilation function is established when exposure to the air, which results in a series of changes in the respiratory, circulatory and endocrine systems and energy metabolisms, etc. The physiological transition can be relfected in heart rate, blood pressure, oxygen saturation, temperature, and other physiological indicators. The changes of these indicators can be used as references for prevention, diagnosis and treatment of neonatal diseases. This review provides an overview of physiological changes and implications in the lung function, circulatory and endocrine systems, and energy metabolism during the transition at birth as well as intervention measures for abnormal fetal-neonatal transition.