Neonatology pp 94-101 | Cite as

Late Preterm Infants at Risk for Short-Term and Long-Term Morbidity and Mortality

  • Avroy A. Fanaroff


Late preterm births were the first group of premature infants who neonatologists treated successfully. Over time with the very low birth weight infants surviving and demanding many resources, near-term infants were relatively ignored and unfortunately were no longer considered to be of high risk by many health care providers. The resurgence of interest in this group, and their renaming to late preterm resulted from the recognition that they were indeed the largest subpopulation of preterm infants, and had an increased mortality when compared to term infants and increased morbidity including transient tachypnea of newborn (TTN), respiratory distress syndrome (RDS), persistent pulmonary hypertension (PPHN), respiratory failure, apnea, temperature instability, jaundice, hypoglycemia, feeding difficulties and a prolonged neonatal intensive care unit (NICU) stay [1, 2, 3, 4, 5]. Furthermore, they have an increased prevalence of cognitive and neuro-developmental problems and a greater rate of readmission to hospital in the first weeks after discharge than term births. Escobar noted that many late preterm infants are never admitted to the NICU [6]. A possible explanation is that clinicians may be making clinical judgments based on infants’ birth weight only rather than gestation and birth weight.


Preterm Birth Neonatal Intensive Care Unit Term Infant Late Preterm Late Preterm Infant 
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  1. 1.
    Raju TN, Higgins RD, Stark AR, Leveno KJ (2006) Optimizing care and outcome for late-preterm (near-term) infants: A summary of the workshop sponsored by the National Institute of Child Health and Human Development. Pediatrics 118:1207–1214PubMedCrossRefGoogle Scholar
  2. 2.
    Engle WA, Tomashek KM, Wallman C et al (2007) “Late-preterm” infants: A population at risk. Pediatrics 120:1390–1401PubMedCrossRefGoogle Scholar
  3. 3.
    Jain L (2007) Morbidity and mortality in late-preterm infants: more than just transient tachypnea! J Pediatr 151:445–446PubMedCrossRefGoogle Scholar
  4. 4.
    Ramachandrappa A, Jain L (2009) Health issues of the late preterm infant. Pediatr Clin North Am 56:565–577PubMedCrossRefGoogle Scholar
  5. 5.
    Jain L (2008) Respiratory morbidity in late-preterm infants: prevention is better than cure! Am J Perinatol 25:75–78PubMedCrossRefGoogle Scholar
  6. 6.
    Escobar GJ, Greene JD, Hulac P et al (2005) Rehospitalisation after birth hospitalisation: patterns among infants of all gestations. Arch Dis Child 90:125–131PubMedCrossRefGoogle Scholar
  7. 7.
    Hamilton BE, Martin JA, Ventura SJ (2010) Births: Preliminary data for 2008. Natl Vital Stat Rep 58(16):1–17PubMedGoogle Scholar
  8. 8.
    American College of Obstetricians and Gynecologists (1999) Induction of labor. Practice Bulletin no. 10. ACOG, Washington, DCGoogle Scholar
  9. 9.
    Davidoff MJ, Dias T, Damus K, et al (2006) Changes in the gestational age distribution among U.S. singleton births: impact on rates of late preterm birth, 1992 to 2002. Semin Perinatol 30:8–15PubMedCrossRefGoogle Scholar
  10. 10.
    Clark SL, Miller DD, Belfort MA et al (2009) Neonatal and maternal outcomes associated with elective term delivery. Am J Obstet Gynecol. 200:156.e1–e4CrossRefGoogle Scholar
  11. 11.
    Oshiro BT, Henry E, Wilson J et al (2009) Decreasing elective deliveries before 39 weeks of gestation in an Integrated health care system. Obstet Gynecol 113:804–811PubMedGoogle Scholar
  12. 12.
    Reddy UM, Ko CW, Raju TNK, Willinger M (2009) Delivery indications at late-preterm gestations and infant mortality rates in the United States. Pediatrics 124:234–240PubMedCrossRefGoogle Scholar
  13. 13.
    Donovan EF, Lannon C, Bailit J et al (2010) A statewide initiative to reduce inappropriate scheduled births at 36(0/7)–38(6/7) weeks’ gestation. Am J Obstet Gynecol 202:243.e1–e8CrossRefGoogle Scholar
  14. 14.
    Bailit JL, Gregory KD, Reddy UM et al (2010) Maternal and neonatal outcomes by labor onset type and gestational age. Am J Obstet Gynecol 202:245.e1–e12CrossRefGoogle Scholar
  15. 15.
    Shapiro-Mendoza CK, Tomashek KM, Kotelchuck M et al (2008) Effect of late-preterm birth and maternal medical conditions on newborn morbidity risk. Pediatrics 121:e223–e232PubMedCrossRefGoogle Scholar
  16. 16.
    Tomashek KM, Shapiro-Mendoza CK, Davidoff MJ, Petrini JR (2007) Differences in mortality between late-preterm and term singleton infants in the United States 1995–2002. J Pediatr 151:450–456PubMedCrossRefGoogle Scholar
  17. 17.
    Kitsommart R, Janes M, Mahajan V et al (2009) Outcomes of latepreterm infants: a retrospective, single-center, Canadian study. Clin Pediatr (Phila) 48:844–850CrossRefGoogle Scholar
  18. 18.
    Cohen-Wolkowiez M, Moran C, Benjamin DK et al (2009) Early and late onset sepsis in late preterm infants. Pediatr Infect Dis J 28:1052–1056PubMedCrossRefGoogle Scholar
  19. 19.
    McLaurin KK, Hall CB, Jackson EA et al (2009) Persistence of morbidity and cost differences between late-preterm and term infants during the first year of life. Pediatrics 123:653–659PubMedCrossRefGoogle Scholar
  20. 20.
    Underwood MA, Danielsen B, Gilbert WM (2007) Cost, causes and rates of rehospitalization of preterm infants. J Perinatol 27:614–619PubMedCrossRefGoogle Scholar
  21. 21.
    Wang ML, Dorer DJ, Fleming MP, Catlin EA (2004) Clinical outcomes sof near-term infants. Pediatrics 114:372–376PubMedCrossRefGoogle Scholar
  22. 22.
    Gowen CW Jr, Lawson EE, Gingras J et al (1988) Electrical potential difference and ion transport across nasal epithelium of term neonates: correlation with mode of delivery, transient tachypnea of the newborn, and respiratory rate. J Pediatr 113:121–127PubMedCrossRefGoogle Scholar
  23. 23.
    Joseph KS, Nette F, Scott H, Vincer MJ (2009) Prenatal corticosteroid prophylaxis for women delivering at late preterm gestation. Pediatrics 124:e835–e843PubMedCrossRefGoogle Scholar
  24. 24.
    Dudell GG, Jain L (2006) Hypoxic respiratory failure in the late preterm infant. Clin Perinatol 33:803–830PubMedCrossRefGoogle Scholar
  25. 25.
    Hunt CE (2006) Ontogeny of autonomic regulation in late preterm infants born at 34–37 weeks postmenstrual age. Semin Perinatol 30:73–76PubMedCrossRefGoogle Scholar
  26. 26.
    Ramanathan R, Corwin MJ, Hunt CE et al (2001) Cardiorespiratory events recorded on home monitors: Comparison of healthy infants with those at increased risk for SIDS. JAMA 285:2199–2207PubMedCrossRefGoogle Scholar
  27. 27.
    Newman TB, Escobar GJ, Gonzales VM et al (1999) Frequency of neonatal bilirubin testing and hyperbilirubinemia in a large health maintenance organization. Pediatrics 104:1198–1203PubMedGoogle Scholar
  28. 28.
    Maisels MJ, Kring E (1998) Length of stay, jaundice and hospital readmission. Pediatrics 101:995–998PubMedCrossRefGoogle Scholar
  29. 29.
    Bhutani VK, Johnson L (2006) Kernicterus in late preterm infants cared for as term healthy infants. Semin Perinatol 30:89–97PubMedCrossRefGoogle Scholar
  30. 30.
    Bhutani VK, Maisels MJ, Stark AR, Buonocore G (2008) Management of jaundice and prevention of severe neonatal hyperbilirubinemia in infants > or = 35 weeks gestation. Neonatology 94:63–67PubMedCrossRefGoogle Scholar
  31. 31.
    Kramer LI (1969) Advancement of dermal icterus in the jaundiced newborn. Am J Dis Child 118:454–458PubMedGoogle Scholar
  32. 32.
    Keren R, Teremont K, Luan X, Cnaan A (2009) Visual assessment of jaundice in term and late preterm infants. Arch Dis Child Fetal Neonatal Ed 94:F317–322PubMedCrossRefGoogle Scholar
  33. 33.
    American Academy of Pediatrics, Subcommittee on Hyperbilirubinemia (2004) Management of hyperbilirubinemia in the newborn infant 35 or more weeks of gestation. Pediatrics 114:297–316CrossRefGoogle Scholar
  34. 34.
    Morse SB, Zheng H, Tang Y, Roth J (2009) Early school-age outcomes of late preterm infants. Pediatrics 123:e622–e629PubMedCrossRefGoogle Scholar
  35. 35.
    Jain L (2008) School outcome in late preterm infants: a cause for concern. J Pediatr 153:5–6PubMedCrossRefGoogle Scholar
  36. 36.
    Gurka MJ, LoCasale-Crouch J, Blackman JA (2010) Long-term cognition, achievement, socio-emotional, and behavioral development of healthy late-preterm infants. Arch Pediatr Adolesc Med 164:525–532PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Italia 2012

Authors and Affiliations

  • Avroy A. Fanaroff
    • 1
  1. 1.Department of Pediatrics, Case Western Reserve University School of MedicineEliza Henry Barnes Chair in Neonatology Rainbow Babies and Children’s HospitalClevelandUSA

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