Temporal trends in neonatal mortality and morbidity following spontaneous and clinician-initiated preterm birth in Washington State, USA: a population-based study

ObjectiveAfter a decade of increase, the preterm birth (PTB) rate has declined in the USA since 2006, with the largest decline at late preterm (34–36 weeks). We described concomitant changes in gestational age-specific rates of neonatal mortality and morbidity following spontaneous and clinician-ini...

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Published in:BMJ open 2019, Vol.9 (1), p.e023004
Main Authors: Richter, Lindsay L, Ting, Joseph, Muraca, Giulia M, Synnes, Anne, Lim, Kenneth I, Lisonkova, Sarka
Format: Article
Language:English
Subjects:
Adult
Body mass index
Delivery, Obstetric - mortality
Epidemiology
Female
Fetal Membranes, Premature Rupture - mortality
Gestational Age
Health risk assessment
Humans
Infant
Infant mortality
Infant Mortality - trends
Infant, Newborn
Logistic Models
Male
Morbidity
Newborn babies
Population-based studies
Pregnancy
Premature babies
Premature birth
Premature Birth - mortality
Retrospective Studies
Time Factors
Washington - epidemiology
Womens health
Young Adult
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creator Richter, Lindsay L
Ting, Joseph
Muraca, Giulia M
Synnes, Anne
Lim, Kenneth I
Lisonkova, Sarka
description ObjectiveAfter a decade of increase, the preterm birth (PTB) rate has declined in the USA since 2006, with the largest decline at late preterm (34–36 weeks). We described concomitant changes in gestational age-specific rates of neonatal mortality and morbidity following spontaneous and clinician-initiated PTB among singleton infants.Design, setting and participantsThis retrospective population-based study included 754 763 singleton births in Washington State, USA, 2004–2013, using data from birth certificates and hospitalisation records. PTB subtypes included preterm premature rupture of membranes (PPROM), spontaneous onset of labour and clinician-initiated delivery.Outcome measuresThe primary outcomes were neonatal mortality and a composite outcome including death or severe neonatal morbidity. Temporal trends in the outcomes and individual morbidities were assessed by PTB subtype. Logistic regression yielded adjusted odds ratios (AOR) per 1 year change in outcome and 95% CI.ResultsThe rate of PTB following PPROM and spontaneous labour declined, while clinician-initiated PTB increased (all p
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We described concomitant changes in gestational age-specific rates of neonatal mortality and morbidity following spontaneous and clinician-initiated PTB among singleton infants.Design, setting and participantsThis retrospective population-based study included 754 763 singleton births in Washington State, USA, 2004–2013, using data from birth certificates and hospitalisation records. PTB subtypes included preterm premature rupture of membranes (PPROM), spontaneous onset of labour and clinician-initiated delivery.Outcome measuresThe primary outcomes were neonatal mortality and a composite outcome including death or severe neonatal morbidity. Temporal trends in the outcomes and individual morbidities were assessed by PTB subtype. Logistic regression yielded adjusted odds ratios (AOR) per 1 year change in outcome and 95% CI.ResultsThe rate of PTB following PPROM and spontaneous labour declined, while clinician-initiated PTB increased (all p&lt;0.01). Overall neonatal mortality remained unchanged (1.3%; AOR 0.99, CI 0.95 to 1.02), though gestational age-specific mortality following clinician-initiated PTB declined at 32–33 weeks (AOR 0.85, CI 0.74 to 0.97) and increased at 34–36 weeks (AOR 1.10, CI 1.01 to 1.20). The overall rate of the composite outcome increased (from 7.9% to 11.9%; AOR 1.06, CI 1.05 to 1.08). Among late preterm infants, combined mortality or severe morbidity increased following PPROM (AOR 1.13, CI 1.08 to 1.18), spontaneous labour (AOR 1.09, CI 1.06 to 1.13) and clinician-initiated delivery (AOR 1.10, CI 1.07 to 1.13). Neonatal sepsis rates increased among all preterm infants (AOR 1.09, CI 1.08 to 1.11).ConclusionsTiming of obstetric interventions is associated with infant health outcomes at preterm. The temporal decline in late PTB among singleton infants was associated with increased mortality among late preterm infants born following clinician-initiated delivery and increased combined mortality or severe morbidity among all late preterm infants, mainly due to increased rate of sepsis.</description><identifier>ISSN: 2044-6055</identifier><identifier>EISSN: 2044-6055</identifier><identifier>DOI: 10.1136/bmjopen-2018-023004</identifier><identifier>PMID: 30782691</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Adult ; Body mass index ; Delivery, Obstetric - mortality ; Epidemiology ; Female ; Fetal Membranes, Premature Rupture - mortality ; Gestational Age ; Health risk assessment ; Humans ; Infant ; Infant mortality ; Infant Mortality - trends ; Infant, Newborn ; Logistic Models ; Male ; Morbidity ; Newborn babies ; Population-based studies ; Pregnancy ; Premature babies ; Premature birth ; Premature Birth - mortality ; Retrospective Studies ; Time Factors ; Washington - epidemiology ; Womens health ; Young Adult</subject><ispartof>BMJ open, 2019, Vol.9 (1), p.e023004</ispartof><rights>Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2019 Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ . Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b543t-a3bde1d48fe241aecd466f4292bd87784bbf2687196cb123287270375b9794b73</citedby><cites>FETCH-LOGICAL-b543t-a3bde1d48fe241aecd466f4292bd87784bbf2687196cb123287270375b9794b73</cites><orcidid>0000-0002-1220-310X ; 0000-0002-5246-8823</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.proquest.com/docview/2174654377/fulltextPDF?pq-origsite=primo$$EPDF$$P50$$Gproquest$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.proquest.com/docview/2174654377?pq-origsite=primo$$EHTML$$P50$$Gproquest$$Hfree_for_read</linktohtml><link.rule.ids>112,113,230,314,723,776,780,881,3181,4010,25731,27526,27527,27900,27901,27902,36989,44566,53766,53768,74869,77337,77338,77344,77375</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30782691$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:141264591$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Richter, Lindsay L</creatorcontrib><creatorcontrib>Ting, Joseph</creatorcontrib><creatorcontrib>Muraca, Giulia M</creatorcontrib><creatorcontrib>Synnes, Anne</creatorcontrib><creatorcontrib>Lim, Kenneth I</creatorcontrib><creatorcontrib>Lisonkova, Sarka</creatorcontrib><title>Temporal trends in neonatal mortality and morbidity following spontaneous and clinician-initiated preterm birth in Washington State, USA: a population-based study</title><title>BMJ open</title><addtitle>BMJ Open</addtitle><description>ObjectiveAfter a decade of increase, the preterm birth (PTB) rate has declined in the USA since 2006, with the largest decline at late preterm (34–36 weeks). We described concomitant changes in gestational age-specific rates of neonatal mortality and morbidity following spontaneous and clinician-initiated PTB among singleton infants.Design, setting and participantsThis retrospective population-based study included 754 763 singleton births in Washington State, USA, 2004–2013, using data from birth certificates and hospitalisation records. PTB subtypes included preterm premature rupture of membranes (PPROM), spontaneous onset of labour and clinician-initiated delivery.Outcome measuresThe primary outcomes were neonatal mortality and a composite outcome including death or severe neonatal morbidity. Temporal trends in the outcomes and individual morbidities were assessed by PTB subtype. Logistic regression yielded adjusted odds ratios (AOR) per 1 year change in outcome and 95% CI.ResultsThe rate of PTB following PPROM and spontaneous labour declined, while clinician-initiated PTB increased (all p&lt;0.01). Overall neonatal mortality remained unchanged (1.3%; AOR 0.99, CI 0.95 to 1.02), though gestational age-specific mortality following clinician-initiated PTB declined at 32–33 weeks (AOR 0.85, CI 0.74 to 0.97) and increased at 34–36 weeks (AOR 1.10, CI 1.01 to 1.20). The overall rate of the composite outcome increased (from 7.9% to 11.9%; AOR 1.06, CI 1.05 to 1.08). Among late preterm infants, combined mortality or severe morbidity increased following PPROM (AOR 1.13, CI 1.08 to 1.18), spontaneous labour (AOR 1.09, CI 1.06 to 1.13) and clinician-initiated delivery (AOR 1.10, CI 1.07 to 1.13). Neonatal sepsis rates increased among all preterm infants (AOR 1.09, CI 1.08 to 1.11).ConclusionsTiming of obstetric interventions is associated with infant health outcomes at preterm. The temporal decline in late PTB among singleton infants was associated with increased mortality among late preterm infants born following clinician-initiated delivery and increased combined mortality or severe morbidity among all late preterm infants, mainly due to increased rate of sepsis.</description><subject>Adult</subject><subject>Body mass index</subject><subject>Delivery, Obstetric - mortality</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Fetal Membranes, Premature Rupture - mortality</subject><subject>Gestational Age</subject><subject>Health risk assessment</subject><subject>Humans</subject><subject>Infant</subject><subject>Infant mortality</subject><subject>Infant Mortality - trends</subject><subject>Infant, Newborn</subject><subject>Logistic Models</subject><subject>Male</subject><subject>Morbidity</subject><subject>Newborn babies</subject><subject>Population-based studies</subject><subject>Pregnancy</subject><subject>Premature babies</subject><subject>Premature birth</subject><subject>Premature Birth - mortality</subject><subject>Retrospective Studies</subject><subject>Time Factors</subject><subject>Washington - epidemiology</subject><subject>Womens health</subject><subject>Young Adult</subject><issn>2044-6055</issn><issn>2044-6055</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>9YT</sourceid><sourceid>PIMPY</sourceid><recordid>eNqNUstO3DAUjaqigihfgFRZ6rahfsV2uqiEUF8SUheAWFp27DCeJnZqO6D5nX5pnWaKYIc393XO8b32rapTBM8QIuyjHrdhsr7GEIkaYgIhfVUdYUhpzWDTvH7iH1YnKW1hObRpmwa_qQ4J5AKzFh1Vf67tOIWoBpCj9SYB54G3watcUmOIxbi8A8qbJdLOLFEfhiE8OH8H0hR8VoUwp3-YbnDedU75utjsVLYGTNFmG0egXcybRf9WpU0h5-DBVS6QD-Dm6vwTUGAK0zyo7IKvtUqFmvJsdm-rg14NyZ7s7XF18_XL9cX3-vLntx8X55e1bijJtSLaWGSo6C2mSNnOUMZ6ilusjeBcUK17zARHLes0wgQLjjkkvNEtb6nm5LiqV930YKdZyym6UcWdDMrJfepX8aykAgkqCv7zii-V0ZrO-lze8RntecW7jbwL95IRhigiReD9XiCG37NNWW7DHH2ZUWLEKStj8aUtsqK6GFKKtn-8AUG57ILc74JcdkGuu1BY754298j5__MFcLYCCvtFin8BLL_FLA</recordid><startdate>2019</startdate><enddate>2019</enddate><creator>Richter, Lindsay L</creator><creator>Ting, Joseph</creator><creator>Muraca, Giulia M</creator><creator>Synnes, Anne</creator><creator>Lim, Kenneth I</creator><creator>Lisonkova, Sarka</creator><general>BMJ Publishing Group LTD</general><general>BMJ Publishing Group</general><scope>9YT</scope><scope>ACMMV</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>BTHHO</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>K9-</scope><scope>K9.</scope><scope>KB0</scope><scope>M0R</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>5PM</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>ZZAVC</scope><orcidid>https://orcid.org/0000-0002-1220-310X</orcidid><orcidid>https://orcid.org/0000-0002-5246-8823</orcidid></search><sort><creationdate>2019</creationdate><title>Temporal trends in neonatal mortality and morbidity following spontaneous and clinician-initiated preterm birth in Washington State, USA: a population-based study</title><author>Richter, Lindsay L ; Ting, Joseph ; Muraca, Giulia M ; Synnes, Anne ; Lim, Kenneth I ; Lisonkova, Sarka</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b543t-a3bde1d48fe241aecd466f4292bd87784bbf2687196cb123287270375b9794b73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Body mass index</topic><topic>Delivery, Obstetric - mortality</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Fetal Membranes, Premature Rupture - mortality</topic><topic>Gestational Age</topic><topic>Health risk assessment</topic><topic>Humans</topic><topic>Infant</topic><topic>Infant mortality</topic><topic>Infant Mortality - trends</topic><topic>Infant, Newborn</topic><topic>Logistic Models</topic><topic>Male</topic><topic>Morbidity</topic><topic>Newborn babies</topic><topic>Population-based studies</topic><topic>Pregnancy</topic><topic>Premature babies</topic><topic>Premature birth</topic><topic>Premature Birth - mortality</topic><topic>Retrospective Studies</topic><topic>Time Factors</topic><topic>Washington - epidemiology</topic><topic>Womens health</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Richter, Lindsay L</creatorcontrib><creatorcontrib>Ting, Joseph</creatorcontrib><creatorcontrib>Muraca, Giulia M</creatorcontrib><creatorcontrib>Synnes, Anne</creatorcontrib><creatorcontrib>Lim, Kenneth I</creatorcontrib><creatorcontrib>Lisonkova, Sarka</creatorcontrib><collection>BMJ Open Access Journals</collection><collection>BMJ Journals:Open Access</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Proquest Nursing &amp; 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We described concomitant changes in gestational age-specific rates of neonatal mortality and morbidity following spontaneous and clinician-initiated PTB among singleton infants.Design, setting and participantsThis retrospective population-based study included 754 763 singleton births in Washington State, USA, 2004–2013, using data from birth certificates and hospitalisation records. PTB subtypes included preterm premature rupture of membranes (PPROM), spontaneous onset of labour and clinician-initiated delivery.Outcome measuresThe primary outcomes were neonatal mortality and a composite outcome including death or severe neonatal morbidity. Temporal trends in the outcomes and individual morbidities were assessed by PTB subtype. Logistic regression yielded adjusted odds ratios (AOR) per 1 year change in outcome and 95% CI.ResultsThe rate of PTB following PPROM and spontaneous labour declined, while clinician-initiated PTB increased (all p&lt;0.01). Overall neonatal mortality remained unchanged (1.3%; AOR 0.99, CI 0.95 to 1.02), though gestational age-specific mortality following clinician-initiated PTB declined at 32–33 weeks (AOR 0.85, CI 0.74 to 0.97) and increased at 34–36 weeks (AOR 1.10, CI 1.01 to 1.20). The overall rate of the composite outcome increased (from 7.9% to 11.9%; AOR 1.06, CI 1.05 to 1.08). Among late preterm infants, combined mortality or severe morbidity increased following PPROM (AOR 1.13, CI 1.08 to 1.18), spontaneous labour (AOR 1.09, CI 1.06 to 1.13) and clinician-initiated delivery (AOR 1.10, CI 1.07 to 1.13). Neonatal sepsis rates increased among all preterm infants (AOR 1.09, CI 1.08 to 1.11).ConclusionsTiming of obstetric interventions is associated with infant health outcomes at preterm. The temporal decline in late PTB among singleton infants was associated with increased mortality among late preterm infants born following clinician-initiated delivery and increased combined mortality or severe morbidity among all late preterm infants, mainly due to increased rate of sepsis.</abstract><cop>England</cop><pub>BMJ Publishing Group LTD</pub><pmid>30782691</pmid><doi>10.1136/bmjopen-2018-023004</doi><orcidid>https://orcid.org/0000-0002-1220-310X</orcidid><orcidid>https://orcid.org/0000-0002-5246-8823</orcidid><oa>free_for_read</oa></addata></record>
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source BMJ Open Access Journals; BMJ; Publicly Available Content Database; PubMed Central
subjects Adult
Body mass index
Delivery, Obstetric - mortality
Epidemiology
Female
Fetal Membranes, Premature Rupture - mortality
Gestational Age
Health risk assessment
Humans
Infant
Infant mortality
Infant Mortality - trends
Infant, Newborn
Logistic Models
Male
Morbidity
Newborn babies
Population-based studies
Pregnancy
Premature babies
Premature birth
Premature Birth - mortality
Retrospective Studies
Time Factors
Washington - epidemiology
Womens health
Young Adult
title Temporal trends in neonatal mortality and morbidity following spontaneous and clinician-initiated preterm birth in Washington State, USA: a population-based study
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