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Unstudied infants: outcomes of moderately premature infants in the neonatal intensive care unit

¹ Kaiser Permanente Medical Care Program, Division of Research, Perinatal Research Unit, Oakland, CA, USA
² Kaiser Permanente Medical Center, Department of Pediatrics, Walnut Creek, CA, USA
³ Department of Society, Human Development and Health, Harvard School of Public Health, Boston, MA, USA
⁴ Department of Neonatology, Beth Israel Deaconess Medical Center, Boston
⁵ Harvard Medical School, Department of Newborn Medicine, Brigham and Women’s Hospital, Boston

Correspondence to:
Correspondence to:
Dr Escobar
Kaiser Permanente Medical Care Program, Division of Research, Perinatal Research Unit, 2000 Broadway, 2nd floor, Oakland, CA 94612, USA; gabriel.escobar{at}kp.org

Background: Newborns of 30–34 weeks gestation comprise 3.9% of all live births in the United States and 32% of all premature infants. They have been studied much less than very low birthweight infants.

Objective: To measure in-hospital outcomes and readmission within three months of discharge of moderately premature infants.

Design: Prospective cohort study including retrospective chart review and telephone interviews after discharge.

Setting: Ten birth hospitals in California and Massachusetts.

Patients: Surviving moderately premature infants born between October 2001 and February 2003.

Main outcome measures: (a) Occurrence of assisted ventilation during the hospital stay after birth; (b) adverse in-hospital outcomes—for example, necrotising enterocolitis; (c) readmission within three months of discharge.

Results: With the use of prospective cluster sampling, 850 eligible infants and their families were identified, randomly selected, and enrolled. A total of 677 families completed a telephone interview three months after hospital discharge. During the birth stay, these babies experienced substantial morbidity: 45.7% experienced assisted ventilation, and 3.2% still required supplemental oxygen at 36 weeks. Readmission within three months occurred in 11.2% of the cohort and was higher among male infants and those with chronic lung disease.

Conclusions: Moderately premature infants experience significant morbidity, as evidenced by high rates of assisted ventilation, use of oxygen at 36 weeks, and readmission. Such morbidity deserves more research.

Abbreviations: NICU, neonatal intensive care unit; PMA, postmenstrual age

Keywords: assisted ventilation; outcomes; prematurity; morbidity; intensive care

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