Morbidity and Mortality in Late Preterm and Early Term Newborns: A Continuum

Engle WA. Morbidity and mortality in late preterm and early term newborns: a continuum. Clin Perinatol. 2011;38(3):493-516. doi:10.1016/j.clp.2011.06.009

Late preterm and early term newborns are at higher risk for morbidities and mortalityduring and after the birth hospitalization than infants born at exactly 39 weeks’ (39 0/7)gestation to 40 weeks plus 6 days’ (40 6/7) gestation. Similarly, newborns deliveredbefore 34 0/7 weeks’ gestation or after 41 6/7 weeks’ gestation are at higher riskthan term infants for complications and death. This article defines late preterm, earlyterm, and late term; summarizes outcomes for these infants; outlines managementpriorities for the neonate and mother/fetus dyad; reviews causes for births before39 weeks’ gestation; and should stimulate research and development of new, effec-tive, and safe care strategies.

Categorizing groups of newborns is valuable to focus attention on common causesof negative outcomes and to develop care strategies to address these causes.However, categorization is arbitrary and blurs the fact that outcomes generally corre-late with gestational age.1–9Biologic variability further complicates the comparison ofoutcomes within gestational age categories. A secondary purpose of this article is tohighlight several important clinical outcomes that are strongly associated with gesta-tional age. Furthermore, it poses the question of whether 34 weeks’ gestation is anoptimal surrogate for fetal maturity and target for delivery when urgent delivery isnot indicated for the safety and health of a woman or her fetus.

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