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Neonatal and 5-Year Outcomes After Birth at 30–34 Weeks of Gestation

¹From the Department of Neonatal Medicine, Rouen University Hospital and Inserm Avenir Research Group, Institute for Biomedical Research, University of Rouen, Rouen, France; ²INSERM UMR S149, IFR69, Epidemiological Research Unit on Perinatal and Women’s Health, Tenon University Hospital and Pierre et Marie Curie University, Paris, France; ³Department of Obstetrics and Gynecology, Rouen University Hospital, Rouen, France; ⁴Department of Neonatal Medicine, Lille University Hospital, Lille, France; ⁵Inserm UMR S149, Epidemiological Research Unit on Perinatal and Women’s Health, Villejuif, and Pierre et Marie Curie University, Paris, France; ⁶Department of Neonatal Medicine, Antoine-Béclère University Hospital, Clamart, France; ⁷Department of Neonatal Medicine, Besançon University Hospital, Besançon, France; ⁸Department of Neonatalogy, Nancy University Hospital, Nancy, France; ⁹Intensive Care Unit and Matermip Network, Toulouse University Hospital, Toulouse, France; ¹⁰Department of Neonatalogy, Nantes University Hospital, Nantes, France; and ¹¹Department of Neonatalogy, Strasbourg University Hospital, Strasbourg, France.

OBJECTIVE: To evaluate the rates of in-hospital death, neonatal complications, and 5-year outcomes of infants born at 30–34 weeks of gestation.

METHODS: In nine regions of France, all 2,020 stillbirths and live births at 30, 31, and 32 weeks in 1997 and all 457 births at 33 and 34 weeks in April and October 1997 were recorded. Survivors were evaluated at 5 years of age.

RESULTS: Increasing gestational age from 30 to 34 weeks was associated with progressive decreases in in-hospital mortality (from 8.1% to 0.4%) and neonatal complications (respiratory distress syndrome, 43.8% to 2.6%; maternofetal infections, 7.2% to 2.6%; and severe white matter injury, 5.5% to 1.3%). Although infants at 33 and 34 weeks of gestation rarely experienced necrotizing enterocolitis, bronchopulmonary dysplasia, or nosocomial infections, they still required endotracheal ventilation, antibiotics, or parenteral nutrition. At 5 years of age, older gestational age was associated with significant decreases in rates of cerebral palsy (6.3% at 30 weeks and 0.7% at 34 weeks) and mild to severe cognitive impairments (35.3% at 30 weeks and 23.9% at 34 weeks). In singletons, preterm rupture of membranes or preterm labor carried an increased risk of cerebral palsy but not of cognitive impairment.

CONCLUSION: Neonates born at 30–34 weeks experienced substantial morbidity and often required admission to neonatal intensive care units. These outcomes suggest that prolonging pregnancies beyond 34 weeks may be desirable whenever possible. Infants born at 30–34 weeks should be carefully monitored to ensure prompt detection and management of neurodevelopmental impairment.

LEVEL OF EVIDENCE: II

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