NICU Admissions After a Policy to Eliminate Elective Early Term Deliveries Before 39 Weeks' Gestation.

TitleNICU Admissions After a Policy to Eliminate Elective Early Term Deliveries Before 39 Weeks' Gestation.
Publication TypeJournal Article
Year of Publication2018
AuthorsKennedy EB, Hacker MR, Miedema D, Pursley DWM, Modest AM, Golen TH, Burris HH
JournalHosp Pediatr
Volume8
Issue11
Pagination686-692
Date Published2018 Nov
ISSN2154-1663
Abstract

BACKGROUND AND OBJECTIVES: Early term infants (37-<39 weeks' gestation) are at higher risk of adverse outcomes than term infants (39-<41 weeks' gestation). We hypothesized that a policy to eliminate elective, early term deliveries would result in fewer NICU admissions and shorter lengths of stay among infants born ≥37 weeks.

METHODS: This was a retrospective cohort study of singleton infants born ≥37 weeks at a tertiary medical center from 2004 to 2015 (preperiod: 2004-2008; postperiod: 2010-2015; washout period: 2009). We compared the incidence of early term delivery, NICU admissions (short: ≥4-<24 hours, long: ≥24 hours), NICU diagnoses, and stillbirths in both periods. We used modified Poisson regression to calculate adjusted risk ratios.

RESULTS: There were 20 708 and 24 897 singleton infants born ≥37 weeks in the pre- and postperiod, respectively. The proportion of early term infants decreased from 32.5% to 25.7% ( < .0001). NICU admissions decreased nonsignificantly (9.2% to 8.8%; = .22), with a significant reduction in short NICU stays (5.4% to 4.6%; adjusted risk ratio: 0.85 [95% confidence interval: 0.79-0.93]). Long NICU stays increased slightly (3.8% to 4.2%), a result that was nullified by adjusting for neonatal hypoglycemia. A nonsignificant increase in the incidence of stillbirths ≥37 to <40 weeks was present in the postperiod (7.5 to 10 per 10 000 births; = .46).

CONCLUSIONS: Reducing early term deliveries was associated with fewer short NICU stays, suggesting that efforts to discourage early term deliveries in uncomplicated pregnancies may minimize mother-infant separation in the newborn period.

DOI10.1542/hpeds.2018-0068
Alternate JournalHosp Pediatr
PubMed ID30361206