MORBIDITY-TERM VS. PRETERM NEONATE WITH “MATURE L/S”

Abstract

Though the lecithin/sphingomyelin ratio (L/S) has provided a powerful predictive tool of fetal lung maturity regarding respiratory distress syndrome (RDS), increasing dialogue between neonatologist and obstetrician in a perinatal approach has suggested the potentially dangerous tendency to equate “mature L/S” with “mature fetus”. A retrospective study evaluated the relationship between infant outcome, infant maturity and L/S maturity. During a six year period 385 L/S were reported as “mature”, of these, 41 were excluded for inadequate data, 252 delivered at > 37 wks gestation (tern) and 93 at < 37 wks (pretenn) gestation.

Neonatal mortality was 0% in the 252 term infants and 2% in 93 preterms. Morbidity was 18% in term and 77% in pretenn. In pre-term, selected morbidity showed morbidity was: RDS 2%, RDS type II 22%, asphyxia 19%, apnea and bradycardia 5%, sepsis 4%, suspect sepsis 15%, feeding problems 31%, hypoglycemia 7%, hypocalcemia 14%, and hyperbilirubinemia 3%, and others <1%. Mean hospitalization time was 4 days in term and 12 days in pretenn. Mean laboratory studies per infant was < 2 in term and 15 in pretenn. Thirty-nine percent of the preterm and 9% of the term had at least one x-ray.

Despite a “mature L/S”, a high incidence of problems must still be anticipated in those infants born < 37 wks. gestation.

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