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      Parto pretérmino: reto, reacciones y paradigmas


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          Clinical outcomes of near-term infants.

          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. 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. 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 dollars (mean) and 429 dollars (median) per near-term infant. 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.
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            Epidemiology and causes of preterm birth

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              The economic consequences of preterm birth during the first 10 years of life.

              To examine the association between gestational age at the time of birth and long-term use and cost of hospital inpatient services. Multi-level modelling of the hospital service utilisation and cost profile of each child born in hospital during 1978-1988 in two areas covered by the Oxford Record Linkage Study. Oxfordshire and West Berkshire. 117,212 children divided into four subgroups by gestational age at birth: <28 weeks, 28-31 weeks, 32-36 weeks, 37 weeks or greater. Number and duration of hospital admissions during the first 10 years of life. Costs, expressed in pound sterling and valued at 1998-1999 prices, of hospital inpatient services. The cumulative cost of hospital inpatient admissions incurred during the first 10 years of life, including the initial birth admission, averaged 17,819.94 [22,322.87 UK pounds] for children born at <28 weeks gestation, 17,751.00 [19,055.53 UK pounds] for children born at 28-31 weeks gestation, 5,376.39 [7,393.78 UK pounds] for children born at 32-36 weeks gestation, and 1,658.63 [3,409.14 UK pounds] for children born at 37 weeks gestation or greater. The adjusted number of hospital inpatient admissions, inpatient days and costs, respectively, over the first 10 years of life was 130%, 77% and 443% higher for children born at <28 weeks gestation than for children born at term. The adverse sequelae of preterm birth are likely to have considerable long-term economic consequences for the health services and for society as a whole.

                Author and article information

                Role: ND
                Revista de Obstetricia y Ginecología de Venezuela
                Rev Obstet Ginecol Venez
                Sociedad de Obstetricia y Ginecología de Venezuela (Caracas )
                December 2012
                : 72
                : 4
                : 217-220



                SciELO Venezuela

                Self URI (journal page): http://www.scielo.org.ve/scielo.php?script=sci_serial&pid=0048-7732&lng=en

                Obstetrics & Gynecology
                Obstetrics & Gynecology


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