Best on time, not a little early: gestational age and outcomes for neonates with congenital heart disease.

H uman gestation lasts 40 weeks from the date of the last menstrual cycle. Neonates born 3 weeks before (37 weeks gestation) through 2 weeks after 40 weeks of gestation are considered as being born at term. This classification is based on the presumption that no differences in neonatal outcomes exist for those born during this 5-week period. Neonates born at or after 37 weeks of gestation, but before 39 weeks gestation, are thought to have matured adequately to allow an uneventful transition to postnatal life. Elective delivery on or after 37 weeks of gestation is therefore being increasingly used for medical (maternal and fetal) and nonmedical reasons. 2,3 Recent research on gestational age and outcomes has shown that considerable differences exist in mortality and morbidity for neonates born during that 5-week time period. These reports also show that otherwise healthy neonates born at early-term (37 or 38 weeks) gestation have increased risk of poor outcomes in comparison with those born later at term (39 or 40 weeks) gestation. Neonates born at early-term gestation have been shown to have a higher incidence of respiratory failure requiring mechanical ventilation, surfactant deficiency and hyaline membrane disease, transient tachypnea of newborn, need for neonatal intensive care unit admission, low 5-minute APGAR scores, and hypoglycemia than those born at term gestation. 7 studied the association of early-term delivery and a composite neonatal mortality and morbidity outcome containing neonatal death, respiratory complications, hypoglycemia, sepsis, and the need for neonatal intensive care in a cohort of neonates delivered electively by repeat cesarean delivery at or after 37 weeks gestation. In comparison with neonates born at 39 weeks gestation, those born at 37 (adjusted odds ratio for poor outcome, 2.1) and 38 (adjusted odds ratio for poor outcome, 1.5) weeks gestation had increased odds of the poor outcomes. Other studies have shown similar results for neo-nates born electively at early term for nonmedical indications. Some studies have also shown that poorer outcomes for early-term deliveries may be more common in those delivered by elective cesarean delivery before the onset of labor. 2,7 Because these concerning findings have been consistent in many investigations , efforts to reduce the rate of elective delivery without medical indications before 39 weeks gestation are underway. 2 Early-term delivery may be needed for certain medical indications including maternal or fetal conditions, and, in some circumstances, early birth may improve neonatal outcomes. A committee …