title: Neonatal outcomes and delivery of care for infants born late preterm or moderately preterm: a prospective population-based study.
abstract: OBJECTIVE
  To describe neonatal outcomes and explore variation in delivery of care for infants born late (34-36  weeks) and moderately (32-33 weeks) preterm (LMPT).
  
  
  METHODS
  Prospective population-based study comprising births in four major maternity centres, one midwifery-led unit and at home between September 2009 and December 2010. Data were obtained from maternal and neonatal records.
  
  
  METHODS
  All LMPT infants were eligible. A random sample of term-born infants (≥37 weeks) acted as controls.
  
  
  METHODS
  Neonatal unit (NNU) admission, respiratory and nutritional support, neonatal morbidities, investigations, length of stay and postnatal ward care were measured. Differences between centres were explored.
  
  
  RESULTS
  1146 (83%) LMPT and 1258 (79% of eligible) term-born infants were recruited. LMPT infants were significantly more likely to receive resuscitation at birth (17.5% vs 7.4%), respiratory (11.8% vs 0.9%) and nutritional support (3.5% vs 0.3%) and were less likely to be fed breast milk (64.2% vs 72.2%) than term infants. For all interventions and morbidities, a gradient of increasing risk with decreasing gestation was evident. Although 60% of late preterm infants were never admitted to a NNU, 83% required medical input on postnatal wards. Clinical management differed significantly between services.
  
  
  CONCLUSIONS
  LMPT infants place high demands on specialist neonatal services. A substantial amount of previously unreported specialist input is provided in postnatal wards, beyond normal newborn care. Appropriate expertise and planning of early care are essential if such infants are managed away from specialised neonatal settings. Further research is required to clarify optimal and cost-effective postnatal management for LMPT babies.
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: Elaine M
authors.initials: EM
authors.lastname: Boyle
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: Samantha
authors.initials: S
authors.lastname: Johnson
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: Bradley
authors.initials: B
authors.lastname: Manktelow
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Seaton
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Draper
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: Lucy K
authors.initials: LK
authors.lastname: Smith
authors.affiliation: Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.
authors.forename: Jon
authors.initials: J
authors.lastname: Dorling
authors.affiliation: UCL EGA Institute for Women's Health, London, UK.
authors.forename: Neil
authors.initials: N
authors.lastname: Marlow
authors.affiliation: Warwick Clinical Trials Unit, University of Warwick, Coventry, UK.
authors.forename: Stavros
authors.initials: S
authors.lastname: Petrou
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: David J
authors.initials: DJ
authors.lastname: Field
mesh_terms: D003695:Delivery of Health Care / Q000379:methods*; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000628:therapy*; D007902:Length of Stay; D008297:Male; D009017:Morbidity; D011247:Pregnancy; D011446:Prospective Studies
keywords: late preterm; moderately preterm; neonatal outcomes; prematurity
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