{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T14:49:03Z","timestamp":1785768543818,"version":"3.56.0"},"reference-count":45,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2021,3,23]],"date-time":"2021-03-23T00:00:00Z","timestamp":1616457600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Although the risk of neonatal mortality is generally low for late preterm and early term infants, they are still significantly predisposed to severe neonatal morbidity (SNM) despite being born at relatively advanced gestations. In this study, we investigated maternal and intrapartum risk factors for early SNM in late preterm and early term infants. This was a retrospective cohort study of non-anomalous, singleton infants (34+0\u201338+6 gestational weeks) born at the Mater Mother\u2019s Hospital in Brisbane, Australia from January 2015 to May 2020. Early SNM was defined as a composite of any of the following severe neonatal outcome indicators: admission to neonatal intensive care unit (NICU) in conjunction with an Apgar score &lt;4 at 5 min, severe respiratory distress, severe neonatal acidosis (cord pH &lt; 7.0 or base excess &lt;\u221212 mmol\/L). Multivariable binomial logistic regression analyses using generalized estimating equations (GEE) were used to identify risk factors. Of the total infants born at 34+0\u201338+6 gestational weeks, 5.7% had at least one component of the composite outcome. For late preterm infants, pre-existing diabetes mellitus, instrumental birth and emergency caesarean birth for non-reassuring fetal status were associated with increased odds for early SNM, whilst for early term infants, pre-existing and gestational diabetes mellitus, antepartum hemorrhage, instrumental, emergency caesarean and elective caesarean birth were significant risk factors. In conclusion, we identified several risk factors contributing to early SNM in late preterm and early term cohort. Our results suggest that predicted probability of early SNM decreased as gestation increased.<\/jats:p>","DOI":"10.3390\/jcm10061319","type":"journal-article","created":{"date-parts":[[2021,3,23]],"date-time":"2021-03-23T14:08:16Z","timestamp":1616508496000},"page":"1319","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Factors Associated with Increased Risk of Early Severe Neonatal Morbidity in Late Preterm and Early Term Infants"],"prefix":"10.3390","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8276-5143","authenticated-orcid":false,"given":"Tesfaye S.","family":"Mengistu","sequence":"first","affiliation":[{"name":"Mater Research Institute, University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, QLD 4101, Australia"},{"name":"School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, P.O. Box 79, Bahir Dar 6000, Ethiopia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronika","family":"Schreiber","sequence":"additional","affiliation":[{"name":"Mater Research Institute, University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, QLD 4101, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher","family":"Flatley","sequence":"additional","affiliation":[{"name":"Mater Research Institute, University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, QLD 4101, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jane","family":"Fox","sequence":"additional","affiliation":[{"name":"Mater Research Institute, University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, QLD 4101, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0832-4811","authenticated-orcid":false,"given":"Sailesh","family":"Kumar","sequence":"additional","affiliation":[{"name":"Mater Research Institute, University of Queensland, Level 3 Aubigny Place, Raymond Terrace, South Brisbane, QLD 4101, Australia"},{"name":"Faculty of Medicine, The University of Queensland, Herston, QLD 4006, Australia"},{"name":"NHMRC Center of Research Excellence in Stillbirth, Mater Research Institute, University of Queensland, Raymond Terrace, South Brisbane, QLD 4101, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,3,23]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"103.e1","DOI":"10.1016\/j.ajog.2016.01.004","article-title":"Preterm neonatal morbidity and mortality by gestational age: A contemporary cohort","volume":"215","author":"Manuck","year":"2016","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"31","DOI":"10.2471\/BLT.08.062554","article-title":"The worldwide incidence of preterm birth: A systematic review of maternal mortality and morbidity","volume":"88","author":"Beck","year":"2010","journal-title":"Bull. World Health Organ."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1186\/1742-4755-11-61","article-title":"Maternal and perinatal health research priorities beyond 2015: An international survey and prioritization exercise","volume":"11","author":"Souza","year":"2014","journal-title":"Reprod. Health"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"802","DOI":"10.1093\/ije\/dyt251","article-title":"Neonatal morbidity associated with late preterm and early term birth: The roles of gestational age and biological determinants of preterm birth","volume":"43","author":"Brown","year":"2014","journal-title":"Int. J. Epidemiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/j.siny.2018.09.001","article-title":"Epidemiology of late preterm and early term births\u2014An international perspective","volume":"24","author":"Delnord","year":"2019","journal-title":"Semin. Fetal Neonatal Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"e20163331","DOI":"10.1542\/peds.2016-3331","article-title":"The \u201clate preterm\u201d birth\u2014ten years later","volume":"139","author":"Raju","year":"2017","journal-title":"Pediatrics"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"493","DOI":"10.1016\/j.clp.2011.06.009","article-title":"Morbidity and Mortality in Late Preterm and Early Term Newborns: A Continuum","volume":"38","author":"Engle","year":"2011","journal-title":"Clin. Perinatol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"F36","DOI":"10.1136\/archdischild-2017-313697","article-title":"Wide variation in severe neonatal morbidity among very preterm infants in European regions","volume":"104","author":"Bonamy","year":"2018","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e000424","DOI":"10.1136\/bmjpo-2018-000424","article-title":"Cross-validated prediction model for severe adverse neonatal outcomes in a term, non-anomalous, singleton cohort","volume":"3","author":"Flatley","year":"2019","journal-title":"BMJ Paediatr. Open"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1039","DOI":"10.1001\/jama.2015.10244","article-title":"Trends in Care Practices, Morbidity, and Mortality of Extremely Preterm Neonates, 1993\u20132012","volume":"314","author":"Stoll","year":"2015","journal-title":"JAMA"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"S2","DOI":"10.1186\/1742-4755-10-S1-S2","article-title":"Born Too Soon: The global epidemiology of 15 million preterm births","volume":"10","author":"Blencowe","year":"2013","journal-title":"Reprod. Health"},{"key":"ref_12","first-page":"10","article-title":"Late Preterm Birth","volume":"3","author":"Loftin","year":"2010","journal-title":"Rev. Obstet. Gynecol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1097\/AOG.0000000000002419","article-title":"Long-term Trends in Singleton Preterm Birth in South Australia from 1986 to 2014","volume":"131","author":"Verburg","year":"2018","journal-title":"Obstet. Gynecol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"784","DOI":"10.1111\/j.1440-1754.2012.02536.x","article-title":"Increasing rates of prematurity and epidemiology of late preterm birth","volume":"48","author":"Cheong","year":"2012","journal-title":"J. Paediatr. Child Health"},{"key":"ref_15","unstructured":"Pink, B. (2008). Information Paper: An Introduction to Socio-Economic Indexes for Areas (SEIFA), 2006."},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Hosmer, D.W., Lemeshow, S., and Sturdivant, R.X. (2013). Applied Logistic Regression, John Wiley & Sons.","DOI":"10.1002\/9781118548387"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"993","DOI":"10.1016\/j.jclinepi.2010.11.012","article-title":"Performance of logistic regression modeling: Beyond the number of events per variable, the role of data structure","volume":"64","author":"Courvoisier","year":"2011","journal-title":"J. Clin. Epidemiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"5512","DOI":"10.1002\/sim.3148","article-title":"Selection of important variables and determination of functional form for continuous predictors in multivariable model building","volume":"26","author":"Sauerbrei","year":"2007","journal-title":"Stat. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1406","DOI":"10.1016\/j.jclinepi.2015.02.002","article-title":"A simulation study of sample size demonstrated the importance of the number of events per variable to develop prediction models in clustered data","volume":"68","author":"Wynants","year":"2015","journal-title":"J. Clin. Epidemiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1177\/1536867X0700700205","article-title":"QIC Program and Model Selection in GEE Analyses","volume":"7","author":"Cui","year":"2007","journal-title":"Stata J. Promot. Commun. Stat. Stata"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"525.e1","DOI":"10.1016\/j.ajog.2018.02.008","article-title":"Term small-for-gestational-age infants from low-risk women are at significantly greater risk of adverse neonatal outcomes","volume":"218","author":"Madden","year":"2018","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1111\/ajo.12849","article-title":"The burden of adverse obstetric and perinatal outcomes from maternal smoking in an Australian cohort","volume":"59","author":"Li","year":"2019","journal-title":"Aust. N. Z. J. Obstet. Gynaecol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"61","DOI":"10.2188\/jea.JE20100092","article-title":"Smoking During Pregnancy Increases Risks of Various Obstetric Complications: A Case-Cohort Study of the Japan Perinatal Registry Network Database","volume":"21","author":"Hayashi","year":"2011","journal-title":"J. Epidemiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"e196405","DOI":"10.1001\/jamanetworkopen.2019.6405","article-title":"Prenatal Risk Factors and Perinatal and Postnatal Outcomes Associated with Maternal Opioid Exposure in an Urban, Low-Income, Multiethnic US Population","volume":"2","author":"Azuine","year":"2019","journal-title":"JAMA Netw. Open"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1515\/jpm-2019-0422","article-title":"Maternal smoking and cannabis use during pregnancy and infant outcomes","volume":"48","author":"Sarah","year":"2020","journal-title":"J. Perinat. Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12884-019-2252-4","article-title":"A large proportion of poor birth outcomes among Aboriginal Western Australians are attributable to smoking, alcohol and substance misuse, and assault","volume":"19","author":"Gibberd","year":"2019","journal-title":"BMC Pregnancy Childbirth"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1337","DOI":"10.1111\/aogs.12757","article-title":"Maternal and neonatal outcomes of pregnancy in women with chronic hypertension: A retrospective analysis of a national register","volume":"94","author":"Broekhuijsen","year":"2015","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"e1919498","DOI":"10.1001\/jamanetworkopen.2019.19498","article-title":"Patient and Hospital Factors Associated With Unexpected Newborn Complications Among Term Neonates in US Hospitals","volume":"3","author":"Clapp","year":"2020","journal-title":"JAMA Netw. Open"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"419","DOI":"10.1001\/jama.2010.1015","article-title":"Respiratory Morbidity in Late Preterm Births","volume":"304","author":"Hibbard","year":"2010","journal-title":"JAMA"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1097\/AOG.0b013e3181af6931","article-title":"Short-term Neonatal Outcome in Low-Risk, Spontaneous, Singleton, Late Preterm Deliveries","volume":"114","author":"Melamed","year":"2009","journal-title":"Obstet. Gynecol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"367.e1","DOI":"10.1016\/j.ajog.2008.08.002","article-title":"Adverse neonatal outcomes: Examining the risks between preterm, late preterm, and term infants","volume":"199","author":"Bastek","year":"2008","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1055\/s-2007-1022470","article-title":"Incidence of Respiratory Disorders in Neonates Born between 34 and 36 Weeks of Gestation Following Exposure to Antenatal Corticosteroids between 24 and 34 Weeks of Gestation","volume":"25","author":"Ventolini","year":"2008","journal-title":"Am. J. Perinatol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1542\/peds.2008-3232","article-title":"Delivery Indications at Late-Preterm Gestations and Infant Mortality Rates in the United States","volume":"124","author":"Reddy","year":"2009","journal-title":"Pediatrics"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"3278","DOI":"10.1080\/14767058.2018.1462325","article-title":"Medically indicated late preterm delivery and its impact on perinatal morbidity and mortality: A retrospective population-based cohort study","volume":"32","author":"Besser","year":"2019","journal-title":"J. Matern. Neonatal Med."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Grace, R., Greer, M., and Kumar, S. (2015). Perinatal consequences of a category 1 caesarean section at term. BMJ Open, 5.","DOI":"10.1136\/bmjopen-2014-007248"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1335","DOI":"10.1080\/14767058.2017.1315666","article-title":"The relationship between the five minute Apgar score, mode of birth and neonatal outcomes","volume":"31","author":"Thavarajah","year":"2018","journal-title":"J. Matern. Neonatal Med."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"135","DOI":"10.1016\/j.ejogrb.2014.07.041","article-title":"Mode of delivery has an independent impact on neonatal condition at birth","volume":"181","author":"Prior","year":"2014","journal-title":"Eur. J. Obstet. Gynecol. Reprod. Biol."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1053","DOI":"10.1001\/jamapediatrics.2013.2581","article-title":"Adverse Neonatal Outcomes Associated with Early-Term Birth","volume":"167","author":"Sengupta","year":"2013","journal-title":"JAMA Pediatr."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"F502","DOI":"10.1136\/archdischild-2018-315147","article-title":"Establishing a composite neonatal adverse outcome indicator using English hospital administrative data","volume":"104","author":"Knight","year":"2019","journal-title":"Arch. Dis. Child. Fetal Neonatal Ed."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"628.e1","DOI":"10.1016\/j.ajog.2016.06.043","article-title":"Small-for-gestational-age infants among uncomplicated pregnancies at term: A secondary analysis of 9 Maternal-Fetal Medicine Units Network studies","volume":"215","author":"Truong","year":"2016","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"511","DOI":"10.1097\/AOG.0000000000002199","article-title":"Neonatal Morbidity of Small- and Large-for-Gestational-Age Neonates Born at Term in Uncomplicated Pregnancies","volume":"130","author":"Chauhan","year":"2017","journal-title":"Obstet. Gynecol."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"303","DOI":"10.1093\/eurpub\/ckx131","article-title":"International variations in the gestational age distribution of births: An ecological study in 34 high-income countries","volume":"28","author":"Delnord","year":"2017","journal-title":"Eur. J. Public Health"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"66","DOI":"10.3389\/fpubh.2017.00066","article-title":"Applying Precision Public Health to Prevent Preterm Birth","volume":"5","author":"Newnham","year":"2017","journal-title":"Front. Public Health"},{"key":"ref_44","doi-asserted-by":"crossref","unstructured":"Burger, R.J., Temmink, J.D., Wertaschnigg, D., Ganzevoort, W., Reddy, M., Davey, M., Wallace, E.M., and Mol, B. (2020). Trends in singleton preterm birth in Victoria, 2007 to 2017: A consecutive cross-sectional study. Acta Obstet. Gynecol. Scand.","DOI":"10.1111\/aogs.14074"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Bouchet, N., Gayet-Ageron, A., Areta, M.L., Pfister, R.E., and de Tejada, B.M. (2018). Avoiding late preterm deliveries to reduce neonatal complications: An 11-year cohort study. BMC Pregnancy Childbirth, 18.","DOI":"10.1186\/s12884-017-1650-8"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/6\/1319\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T05:39:38Z","timestamp":1760161178000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/6\/1319"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,3,23]]},"references-count":45,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2021,3]]}},"alternative-id":["jcm10061319"],"URL":"https:\/\/doi.org\/10.3390\/jcm10061319","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,3,23]]}}}