"Conventional wisdom has been that babies who were near-term but still premature would do as well as full-term babies. They stay in the normal nursery and usually go home when the mother is discharged," says Marvin Wang, MD, of the MGHC Neonatology Unit, who led the study. "But those of us who take care of these children know from experience that they may have more jaundice or hypoglycemia than full-term infants do. No one had ever studied that assumption, so we decided to start the dialogue and examine whether these babies need additional health services."
The research team examined records of infants born at Massachusetts General Hospital over a three-year period. They randomly selected groups of full-term (37 or more weeks) and near-term newborns for whom adequate information was available and who had no major health issues at birth, ending up with 95 full-term and 90 near-term infants. In addition to reviewing their charts for problems that developed during the infants' hospital stay, they also analyzed the costs incurred.
The near-term infants had significantly greater risk than did full-term infants of being diagnosed with many clinical problems – including jaundice, hypoglycemia (low blood sugar), respiratory distress, the need for intravenous feeding, and difficulty maintaining body temperature. They were also more likely to have multiple problems; 18 of the near-term infants had six or more diagnoses, a situation found in none of the full-term babies.
"Overwhelmingly, the near-term babies performed worse for every diagnosis studied," Wang says. "Another important point is that, for some diagnoses, the treatment is different between premature and full-term infants. For example, respiratory distress usually signals infection in full-term infants; but in premature infants it is more likely caused by lung immaturity. Our results suggest we need to carefully examine how we treat children who are in between those two categories."
Wang also notes that recent news reports have described some mothers – including celebrities – who have chosen to have their babies delivered before their due date by elective Cesarean to avoid effects like muscle tearing or stretch marks and to better fit their schedules. "There can be valid medical reasons for delivering early, but our study calls into question the presumption that elective delivery at 35 or 36 weeks poses no risk to the infant," he says.
In terms of health costs, the initial hospital stays of the near-term infants cost an average of $2,600 more than did those of full-term infants, despite the fact that the average length of stay was the same for both groups. The researchers note that future studies should look at longer-term outcomes for near-term infants to identify any continuing health effects. "There are many 35- or 36-week infants who do just as well as full-term babies, but our results indicate we should have a lower threshold of concern about the possibility that these children may be at risk for health problems," says Wang, who is a clinical instructor in Pediatrics at Harvard Medical School.
Wang's coauthors are senior author Elizabeth Catlin, MD, of MassGeneral Hospital for Children; David Dorer, PhD, of Massachusetts General Hospital; and Michael Fleming of Partners HealthCare System. The study was supported by a grant from the William Randolph Hearst Foundation.
MassGeneral Hospital for Children, the pediatric service of Massachusetts General Hospital, is the oldest provider of pediatric services in Boston. It is consistently listed in the U.S. News and World Report Guide to America's Best Hospitals and was ranked number 17 in the 2004 edition. Through its growing network of community-based facilities and pediatricians, the hospital's excellent care is conveniently accessible to families throughout the region.
Massachusetts General Hospital, established in 1811, is the original and largest teaching hospital of Harvard Medical School. The MGH conducts the largest hospital-based research program in the United States, with an annual research budget of more than $400 million and major research centers in AIDS, cardiovascular research, cancer, cutaneous biology, medical imaging, neurodegenerative disorders, transplantation biology and photomedicine. In 1994, MGH and Brigham and Women's Hospital joined to form Partners HealthCare System, an integrated health care delivery system comprising the two academic medical centers, specialty and community hospitals, a network of physician groups, and nonacute and home health services.
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