Neonatal and 5-year outcomes after birth at 30-34 weeks of gestation.
OBJECTIVE
To evaluate the rates of in-hospital death, neonatal complications, and 5-year outcomes of infants born at 30-34 weeks of gestation.


METHODS
In nine regions of France, all 2,020 stillbirths and live births at 30, 31, and 32 weeks in 1997 and all 457 births at 33 and 34 weeks in April and October 1997 were recorded. Survivors were evaluated at 5 years of age.


RESULTS
Increasing gestational age from 30 to 34 weeks was associated with progressive decreases in in-hospital mortality (from 8.1% to 0.4%) and neonatal complications (respiratory distress syndrome, 43.8% to 2.6%; maternofetal infections, 7.2% to 2.6%; and severe white matter injury, 5.5% to 1.3%). Although infants at 33 and 34 weeks of gestation rarely experienced necrotizing enterocolitis, bronchopulmonary dysplasia, or nosocomial infections, they still required endotracheal ventilation, antibiotics, or parenteral nutrition. At 5 years of age, older gestational age was associated with significant decreases in rates of cerebral palsy (6.3% at 30 weeks and 0.7% at 34 weeks) and mild to severe cognitive impairments (35.3% at 30 weeks and 23.9% at 34 weeks). In singletons, preterm rupture of membranes or preterm labor carried an increased risk of cerebral palsy but not of cognitive impairment.


CONCLUSIONS
Neonates born at 30-34 weeks experienced substantial morbidity and often required admission to neonatal intensive care units. These outcomes suggest that prolonging pregnancies beyond 34 weeks may be desirable whenever possible. Infants born at 30-34 weeks should be carefully monitored to ensure prompt detection and management of neurodevelopmental impairment.
Marret
Stéphane
S
Department of Neonatal Medicine, Rouen University Hospital and Inserm Avenir Research Group, Institute for Biomedical Research, University of Rouen, Rouen, France. stephane.marret@chu-rouen.fr
Ancel
Pierre-Yves
PY
Marpeau
Loïc
L
Marchand
Laetitia
L
Pierrat
Véronique
V
Larroque
Béatrice
B
Foix-L'Hélias
Laurence
L
Thiriez
Gérard
G
Fresson
Jeanne
J
Alberge
Corinne
C
Rozé
Jean-Christophe
JC
Matis
Jacqueline
J
Bréart
Gérard
G
Kaminski
Monique
M
D002547:Cerebral Palsy / Q000453:epidemiology*; D002675:Child, Preschool; D003072:Cognition Disorders / Q000453:epidemiology*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005602:France / Q000453:epidemiology; D005865:Gestational Age; D006801:Humans; D015994:Incidence; D007226:Infant Mortality; D007231:Infant, Newborn; D015931:Intensive Care, Neonatal / Q000706:statistics & numerical data; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data; D011247:Pregnancy; D011263:Pregnancy Trimester, Third; D047928:Premature Birth; D012189:Retrospective Studies; D050497:Stillbirth / Q000453:epidemiology