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PEDIATRICS Vol. 114 No. 2 August 2004, pp. 372-376

Clinical Outcomes of Near-Term Infants

Marvin L. Wang, MD*, David J. Dorer, PhD{ddagger}, Michael P. Fleming, MBA§ and Elizabeth A. Catlin, MD*

* Neonatology Unit, Pediatric Service, MassGeneral Hospital for Children, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
{ddagger} Biostatistics Unit, Massachusetts General Hospital, Boston, Massachusetts
§ Service Line Analysis, Partners HealthCare, Boston, Massachusetts

Objective. To test the hypothesis that near-term infants have more medical problems after birth than full-term infants and that hospital stays might be prolonged and costs increased.

Methods. Electronic medical record database sorting was conducted of 7474 neonatal records and subset analyses of near-term (n = 120) and full-term (n = 125) neonatal records. Cost information was accessed. Length of hospital stay, Apgar scores, clinical diagnoses (temperature instability, jaundice, hypoglycemia, suspicion of sepsis, apnea and bradycardia, respiratory distress), treatment with an intravenous infusion, delay in discharge to home, and hospital costs were assessed.

Results. Data from 90 near-term and 95 full-term infants were analyzed. Median length of stay was similar for near-term and full-term infants, but wide variations in hospital stay were documented for near-term infants after both vaginal and cesarean deliveries. Near-term and full-term infants had comparable 1- and 5-minute Apgar scores. Nearly all clinical outcomes analyzed differed significantly between near-term and full-term neonates: temperature instability, hypoglycemia, respiratory distress, and jaundice. Near-term infants were evaluated for possible sepsis more frequently than full-term infants (36.7% vs 12.6%; odds ratio: 3.97) and more often received intravenous infusions. Cost analysis revealed a relative increase in total costs for near-term infants of 2.93 (mean) and 1.39 (median), resulting in a cost difference of $2630 (mean) and $429 (median) per near-term infant.

Conclusions. Near-term infants had significantly more medical problems and increased hospital costs compared with contemporaneous full-term infants. Near-term infants may represent an unrecognized at-risk neonatal population.

Key Words: neonate • outcome • prematurity • near term • costs • newborn

Abbreviations: OR, odds ratio • CI, confidence interval • FE, Fisher exact test • TTN, transient tachypnea of the newborn

Received for publication Apr 4, 2003; Accepted Dec 22, 2003.




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