The thesis is dedicated to the issue of solving a scientific task of enhancing medical care for preterm infants with a gestational age of 34 (0/7) – 36 (6/7) weeks by predicting the probability of adaptation disorders, developing an algorithm of management of late preterm infants based on a study of the main risk factors related to premature birth, perinatal pathologies and peculiarities of postnatal adaptation and the structure of perinatal pathologies in late preterm infants.
The determination of risk factors of preterm birth of late preterm infants was carried out with 266 mother-infant pairs. The research subjects were divided into 2 groups. One hundred and fifty-eight late preterm infants and their mothers were included in the main group, while the comparison group included 108 term infants and their mothers. The risk factors of perinatal pathologies in late preterm infants and the assessment of the probability of postnatal adaptation disorders in late preterm infants were carried out on 158 mother-infant pairs that were divided into 2 groups. Group I included 97 late preterm infants with perinatal pathologies and adaptation disorders who required intensive care. Group II included 61 clinically healthy late preterm infants as well as their mothers. Studying the peculiarities of postnatal adaptation and structure of perinatal pathologies was conducted on 97 late preterm infants. To determine the peculiarities of adaptation and the structure of perinatal pathologies 97 late preterm infants of I group were divided into 3 gestational subgroups: Subgroup Ia included infants with the gestational age of 34 (0/7 – 6/7) weeks, n = 29; Subgroup Ib included infants with the gestational age of 35 (0/7 – 6/7) weeks, n = 34; Subgroup Ic included infants with the gestational age of 36 (0/7 – 6/7) weeks, n = 34).
The paper identifies the risk factors of premature birth in late preterm infants: threatened miscarriage (p = 0.005; OR = 2.33), preeclampsia (p = 0.013; OR = 2.93) and premature rupture of fetal membranes (p = 0.021; OR = 2.02). Life-threatening pathological conditions that have an impact on the forecast of the further development of the child and require an urgent childbirth were much more frequent in the group of late preterm infants: fetal distress syndrome (р = 0.018, OR = 2.97) and the premature detachment of the placenta (р = 0.013). The risk factors of perinatal pathologies in late preterm infants are the following: an extreme risk according to the А. Coopland Scale (p = 0.001; OR = 12), preeclampsia (p < 0.001; OR = 5.22), placental dysfunction (p < 0.001), polyhydramnios (p = 0.012), fetal distress (p < 0.001), childbirth by Caesarian section (p < 0.001; OR = 8.98).
One-half (53,6%) of late preterm infants required some initial and resuscitative measures in the delivery room. The infants with the gestational age of 36 (0/7 – 6/7) weeks prevailed among the infants that had an intubation performed in the delivery room. The 5th minute Apgar Score lower than 7 was also registered in infants with a gestational age of 36 (0/7 – 6/7) weeks. Condition of 31 (32%) late preterm infants deteriorated over the first day.
The following adaptation disorders were characteristic of late preterm infants: temperature lability (92.8 %), jaundice of prematurity born (89.7 %), weak suck (85.6 %), respiratory distress syndrome (71.1 %), brain immaturity (61.9 %), hypoglycemia (46.4 %), feeding intolerance (33 %), and apnea of prematurity (9.3 %). It has been verified that the frequency of oxaluria in breast fed infants is lower (χ²=20.966; p<0.001; OR = 8.47) than in the case of artificial or mixed feeding. Within the pattern of diseases in late preterm infants during the neonatal period, the leading positions were held by the following diseases: neonatal encephalopathy (30.9 %), early anemia of prematurity (27.8 %), respiratory distress syndrome (19,6 %), intrauterine growth retardation (18.6 %), congenital pneumonia (12.4 %) and necrotizing enterocolitis (12.4 %). Over one-half (54.6 %) of late preterm infants had combined pathologies. It was statistically verified that hypoxic-ischemic encephalopathy was more frequent in 36 (0/7 – 6/7) weeks infants.
The algorithm of predicting the probability of adaptation disorders in preterm infants with a gestational age of 34 (0/7) – 36 (6/7) weeks was developed. Guidelines concerning clinical observation of late preterm infants have been developed and implemented in clinical practices.
Keywords: late preterm infants, postnatal adaptation, perinatal pathologies.
