OBSTETRIC INTERVENTIONS IN PRETERM BIRTH AND THEIR ASSOCIATION WITH NEONATAL INTENSIVE CARE UNIT ADMISSION: AN INTEGRATIVE REVIEW

Abstract

Objective: to analyze scientific evidence on the association between obstetric interventions in preterm birth and neonatal outcomes, with emphasis on the need for Neonatal Intensive Care Unit (NICU) admission. Method: integrative literature review based on the PICO framework, conducted through searches in MEDLINE/PubMed, Embase, and CINAHL databases, covering publications from 2021 to April 2026. Primary studies of different designs — clinical trials, cohorts, and case-control studies — addressing obstetric interventions such as antenatal corticosteroids (ACS), tocolysis, cesarean section, and labor induction in women at risk of preterm birth were included. After screening 1,554 records, 11 studies were included in the final sample. Results: ACS represent the intervention with the strongest scientific support for reducing mortality and respiratory complications in preterm neonates, especially before 34 weeks, with the optimal administration-to-delivery interval being 12 hours to 14 days. In late preterm infants, findings were heterogeneous: some studies reported reduced NICU admission rates, while others identified increases, possibly explained by indication bias. The risk of neonatal hypoglycemia was elevated in deliveries occurring between 12 and 35 hours after the first dose of betamethasone. A complete ACS course was superior to a partial one in preventing high-grade intraventricular hemorrhage and periventricular leukomalacia. No additional benefits were found for ACS rescue courses after preterm premature rupture of membranes, nor significant impact of tocolysis beyond 30 weeks on neonatal outcomes. Conclusion: obstetric management of preterm birth requires individualization, considering gestational age, maternal comorbidities, and healthcare context. Nursing plays a strategic role in early risk identification and intervention planning, contributing to improved maternal and neonatal outcomes.