Late preterms: Auswirkungen des fetalen Geschlechts auf das neonatologische Outcome

Zusammenfassung

Hintergrund:

Die Gruppe der sogenannten späten Frühgeborenen („Late preterm“- Kinder mit einem Gestationsalter von 34⁰/₇–36⁶/₇ Schwangerschaftswochen (SSW)) wird hinsichtlich ihres neonatologischen Outcomes unterschätzt. Bei vor der 29. SSW geborenen Kindern zeigte sich ein für Mädchen vorteilhafter geschlechtsspezifischer Unterschied bezüglich der Morbidität. Ziel dieser Studie ist es, zu prüfen ob diese Ergebnisse auf die Late preterm-Gruppe übertragbar sind.

Methode:

Untersucht wurde das neonatale Outcome bei 528 konsekutiven intensivpflichtigen Einlingen des Gestationsalters 34⁰/₇–36⁶/₇ Wochen.

Ergebnisse:

Neonatologische Komplikationen wurden auf Geschlechtsspezifität geprüft. Jungen (n=292) wiesen signifikant häufiger eine Sepsis (3,8 vs. 0,9%; p=0,0314, x ²-Test), Mädchen signifikant längere Aufenthalte auf der neonatologischen Intensivstation auf (Median 12 (Q1:8; Q3:17) vs. 11 (6;16) Tage; p=0,0149, t-Test). Im multiplen logistischen Regressionsmodell zeigte sich eine grenzwertige Signifikanz für das männliche Geschlecht und für vorzeitigen Blasensprung bezüglich des Auftretens einer Sepsis – ein 4,4-faches Risiko für Jungen (OR=0,228 [95% CI: 0,050–1,041]; p=0,0564) und ein 3,5-faches Risiko für vorzeitigen Blasensprung (OR=3,462 [0,938–12,779]; p=0,0623). Als starke Einflussgrößen für die Aufenthaltsdauer auf der Intensivstation zeigten sich nach Adjustierung Geburtsgewicht, Gestationsalter und vorzeitiger Blasensprung.

Schlussfolgerung:

Der Einfluss des fetalen Geschlechtes auf das neonatologische Outcome hat sich in der Late preterm-Gruppe (34⁰/₇–36⁶/₇ SSW) relativiert.

Abstract

Background:

The group of the so-called late preterms (infants born at 34⁰/₇–36⁶/₇ weeks gestational age) has been underestimated with respect to their neonatal outcome. Among infants born before the 29^th week of pregnancy, a gender-specific difference in favour of females regarding morbidity became evident. The aim of this study is to investigate whether these findings are transferable to the group of late preterms.

Methods:

The neonatal outcome of 528 consecutive singletons, born at 34⁰/₇–36⁶/₇ weeks gestational age and requiring intensive care, was examined.

Results:

Neonatal complications have been particularly analysed with regard to gender-specific differences. Boys (n=292) were significantly more frequently affected by sepsis (3.8 vs. 0.9%; p=0,0314, x ²-test). Girls had significantly longer stays in the neonatal intensive care unit (median 12 (Q1:8; Q3:17) vs. 11 (6;16) days; p=0.0149, t-test). In a multiple logistic regression model, male gender and premature rupture of membranes were borderline significant with respect to the occurrence of sepsis – boys had a 4.4-fold risk (OR=0.228 [95% CI: 0.050–1.041]; p=0.0564) and premature rupture of membranes had a 3.5-fold risk (OR=3.462 [0.938–12.779]; p=0.0623). Strong cause variables for the length of stay in the neonatal intensive care unit were birth weight, gestational age and premature rupture of membranes after adjustment.

Conclusion:

The influence of foetal gender on the neonatal outcome in the late preterm group (34⁰/₇–36⁶/₇ gestational age) has been relativised.

Schlüsselwörter

späte Frühgeborene - Geschlechtsspezifität - Gestationsalter - Morbidität - Komplikationen

Key words

late preterms - gender specificity - gestational age - morbidity - complications

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