Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Original Article
  • Published:

Changes in the threshold of fetal lung maturity testing and neonatal outcome of infants delivered electively before 39 weeks gestation: implications and cost-effectiveness

Journal of Perinatology volume 26, pages 264–267 (2006)Cite this article

Abstract

Objective:

To compare the neonatal outcome of infants delivered before 39 weeks' gestation following documentation of fetal lung maturity before and after the lamellar body count (LBC) threshold was increased from 30 000 to 50 000 LB/ul. We discuss the algorithm employed for testing fetal lung maturity, the cost of testing and potential savings.

Material and methods:

We studied the outcome of infants delivered electively before 39 weeks' gestation after fetal lung maturity was documented by amniotic fluid analysis. We compared the outcome of neonates born before and after the LBC threshold was increased.

Results:

Our cohort included 527 neonates who were divided into two groups: 264 who underwent fetal lung maturity studies before the change in LBC threshold and 263 who underwent testing after the change. In the first group, 158 neonates met the criteria of LBC >30 000 LB/ul and were delivered without further testing. The second group included 154 neonates who were mature by LBC >50 000 LB/ul and were delivered. Seven of the neonates born in the first group required admission to the neonatal intensive care unit (NICU), whereas in the second group only two neonates required admission (P=0.02). Additionally, 16 neonates in the first group required respiratory assistance compared with six in the second group (P=0.04). The overall neonatal complication rate was significantly higher in the first group (P=0.001).

Conclusion:

Changing the LBC threshold resulted in a significant decrease in neonatal morbidity. Employing the algorithm, we described for testing fetal lung maturity is cost effective, and more importantly, represents sound evidence-based medical management.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

Similar content being viewed by others

References

  1. American College of Obstetrics and Gynecology ACOG. Educ Bull. No. 230 Nov. 1996; 1–7.

  2. Neerhof MG, Haney EL, Silver RK, Ashwood ER, Lee IS, Piazze JJ et al. Lamellar body counts compared with traditional phospholipid analysis as an assay for evaluating fetal lung maturity. Obstet Gynecol 2001; 97: 305–309.

    CAS  PubMed  Google Scholar 

  3. Neerhof MG, Dohnal JC, Ashwood ER, Lee IS, Anceschi MM . Lamellar body counts: a consensus on protocol. Obstet Gynecol 2001; 97: 318–320.

    CAS  PubMed  Google Scholar 

  4. Ventolini G, Neiger R, Hood D, Belcastro C . Update on assessment of fetal lung maturity. J Obstetr Gynaecol 2005; 25: 535–538.

    Article  CAS  Google Scholar 

  5. Stutchfield P, Rhiannon W, Russell I . On behalf of the Antenatal Steroids for Term Elective Cesarean Section (ASTECS) Research Team. Antenatal betamethasone and incidence of neonatal respiratory distress after elective caesarean section: pragmatic randomized trial. BMJ 2005; 186: 1–6.

    Google Scholar 

  6. Wijnberger LD, Huisjes AJ, Voorbij HA, Franx A, Bruinse HW, Mol BW et al. The accuracy of lamellar body count and lecithin/sphingomyelin ratio in the prediction of neonatal respiratory distress syndrome: a meta-analysis. BJOG 2001; 108 (6) 08: 583–588.

    CAS  PubMed  Google Scholar 

  7. Hunter LA, McKenna DS, Baptista MAC . Comparison of lamellar body counts using light microscopy with standard coulter counter techniques to assess fetal lung maturity. Gynecol Obstet Invest 2005 (17) 61 (1): 29–33.

    Article  Google Scholar 

  8. Kaplan LA, Chapman JF, Bock JL, Santamaria E, Clejan S, Huddleton DJ et al. Prediction of respiratory distress syndrome using the abbott FLM-II amniotic fluid assay. Clin Chim Acta 2002; 326: 61–68.

    Article  CAS  Google Scholar 

  9. Torday JS, Rehan VK . Testing for fetal lung maturation: a biochemical ‘window’ to the developing fetus. Clin Lab Med 2003; 23: 361–383.

    Article  CAS  Google Scholar 

  10. Karcher R, Sykes E, Batton D, Uddin Z, Ross G, Hockman E et al. Gestational age-specific predicted risk of neonatal respiratory distress syndrome using lamellar body count and surfactant-to-albumin ratio in amniotic fluid. Am J Obstet Gynecol 2005; 193: 1680–1684.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Wright State University, Dayton, OH, USA

    G Ventolini & R Neiger

  2. Department of Pathology, Wright State University, Dayton, OH, USA

    D L Hood

  3. Department of Neonatology, Wright State University, Dayton, OH, USA

    M R Belcastro

Authors
  1. G Ventolini
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R Neiger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. D L Hood
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M R Belcastro
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to G Ventolini.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ventolini, G., Neiger, R., Hood, D. et al. Changes in the threshold of fetal lung maturity testing and neonatal outcome of infants delivered electively before 39 weeks gestation: implications and cost-effectiveness. J Perinatol 26, 264–267 (2006). https://doi.org/10.1038/sj.jp.7211501

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/sj.jp.7211501

Keywords

Search

Advanced search

Quick links