Prematurity is a term for the broad category of neonates born at less than 37 weeks’ gestation. Preterm birth is the leading cause of neonatal mortality and the most common reason for antenatal hospitalization.  For premature infants born with a weight below 1000 g, the three primary causes of mortality are respiratory failure, infection, and congenital malformation.
Confirmation of gestational age is based on physical and neurologic characteristics. The Ballard Scoring System remains the main tool clinicians use after delivery to confirm gestational age by means of physical examination.  The major parts of the anatomy used in determining gestational age include the following:
See Clinical Presentation for more detail.
Initial laboratory studies in cases of prematurity are performed to identify issues that, if corrected, improve the patient’s outcome. Such tests include the following:
Imaging studies are specific to the organ system affected. Chest radiography is performed to assess the lung parenchyma and heart size in newborns with respiratory distress. Cranial ultrasonography is performed to detect occult intracranial hemorrhage in premature infants.
Lumbar puncture is performed in premature infants with positive blood cultures and in those who have clinical signs of central nervous system infection. The decision to perform lumbar puncture in ELBW premature infants can sometimes be a difficult one because of their size and the surrounding clinical circumstances. However, when feasible, lumbar puncture should be performed; this will help in determining the duration of antibiotic therapy.
See Workup for more detail.
Stabilization in the delivery room with prompt respiratory and thermal management is crucial to the immediate and long-term outcome of premature infants, particularly extremely premature infants.
It is very important to maintain normal temperature in any newborn, but this is particularly important for premature infants. Use radiant warmers with skin probes to regulate the desired temperature (in general, a normal body temperature of 36.5º-37.5ºC [97.7º-99.5ºF]  ). A heated and humidified isolette is ideal for ELBW infants. Food-grade plastic wrap/sheets can also be very helpful immediately after birth to control humidity and prevent heat loss in ELBW infants. The environmental temperature should be maintained to at least 25ºC (77º F). 
Fluid and electrolyte management
Preterm infants require close monitoring of their fluid and electrolyte levels for several reasons (eg, immature skin increases transepidermal water loss; immature kidney function  ; the use of radiant warming, phototherapy, mechanical ventilation). The degree of prematurity dictates the initial fluid management. The following are general principles of fluid and electrolyte management when caring for premature infants:
Close monitoring of glucose and electrolyte levels as well as acid-base balance is the key when managing ELBW infants. Strict monitoring of input and output is crucial. Thus, urine output, serum electrolyte levels, and daily weight are critical in handling fluids and electrolytes in premature infants.
Prematurity refers to the broad category of neonates born at less than 37 weeks’ gestation. Preterm birth is the leading cause of neonatal mortality and the most common reason for antenatal hospitalization.  Although the estimated date of confinement (EDC) is 40 weeks’ gestation, the World Health Organization (WHO) broadened the range of full term to include 37-42 weeks’ gestation.
Premature newborns have many physiologic challenges when adapting to the extrauterine environment. Most articles in the neonatology section discuss in detail the most serious of these problems. Serious morbidities occur in extremely low birth weight (ELBW) infants. For more information, see Extremely Low Birth Weight Infant, Acute Respiratory Distress Syndrome, Bronchopulmonary Dysplasia, Periventricular Hemorrhage-Intraventricular Hemorrhage. The near-term neonate (34-36 weeks’ gestation) has issues of prematurity that include feeding immaturity, temperature instability, and prolonged jaundice.
This article provides a general overview of the premature infant.
Before birth, the placenta serves three major roles for the fetus: provision of all the nutrients for growth, elimination of fetal waste products, and synthesis of hormones that promote fetal growth.
With the exception of most electrolytes, the maternal circulation contains more substrate (eg, blood glucose) than the fetal circulation. In addition, the placenta is metabolically active and consumes glucose. Waste products of fetal metabolism (eg, heat, urea, bilirubin, carbon dioxide) are transferred across the placenta and eliminated by the mother’s excretory organs (ie, liver, lung, kidneys, skin).
In addition, the placenta acts as a barrier to infection through mucosal macrophages and by allowing transfer of maternal immunoglobulins (immunoglobulins such as immunoglobulin G [IgG]) to the fetus beginning at 32-34 weeks’ gestation. Placental dysfunction is involved in the transfer of IgG. Antibacterial activity of the amniotic fluid improves as gestational age advances.
Each of the immature organs of a premature infant has functional limitations. The tasks of caregivers in neonatal intensive care units (NICUs) are to recognize and monitor the needs of each infant and to provide appropriate support until functional maturity can be achieved.
Premature delivery can be the result of preterm labor and preterm premature rupture of the membranes (PPROM), or it can be due to maternal indications (eg, pregnancy-induced hypertension).
Maternal fever (>38ºC [>100.4ºF]), fetal tachycardia, maternal leukocytosis (>15,000-18,000/mm3 [15-18 × 109/L]), and uterine tenderness are universally accepted signs and symptoms of chorioamnionitis. Amniocentesis that demonstrates bacteria, white blood cells (WBCs), and a low glucose concentration confirms the diagnosis of chorioamnionitis and is an indication for delivery.
A decrease in the biophysical score or profile in association with chorioamnionitis is associated with fetal infection.
Rates of perinatal mortality, neonatal infection, and respiratory distress syndrome (RDS) increase in the presence of maternal fever and chorioamnionitis.
Intrauterine growth restriction is significantly associated with perinatal mortality and long-term morbidity.
Programs offering additional social support for at-risk pregnant women have not been demonstrated to reduce the numbers of extremely low birth weight (ELBW) or preterm infants.
Pregnancies complicated by diabetes and poor glycemic control are associated with a high incidence of prematurity, macrosomia, malformation, fetal death, and neonatal death. 
The rate of preterm birth (<37 weeks’ gestation) is 20-22% of persons with insulin-dependent diabetes.
In women with diabetes diagnosed before pregnancy, the frequency of preeclampsia is increased as the severity of diabetes increases. 
Women with multiple gestation pregnancies are at high risk of preterm labor and delivery and account for an increasing percentage of preterm births and ELBW infants. Preterm birth rate for twins increased from 40.9% in 1981 to 55% in 1997. 
Multiple births related to infertility treatment have dramatically increased.  With advances in assisted reproductive technology, multiple gestation pregnancies have increased.  Prepregnancy counseling of prospective parents regarding the risks related to multiple gestations is important.
Preterm birth (<35 weeks’ gestation) occurs in 26% of twins compared with 3% of singletons.
Triplet pregnancies are associated with an increased incidence of preterm labor and delivery at a decreased gestational age and birth weight, compared with singletons and twins.  When the data are controlled for gestational age, outcomes are similar for singletons, twins, and triplets.
In women aged 13-15 years, the rate of preterm birth is 5.9%.  This rate declines to 1.7% in women aged 18-19 years and 1.1% in women aged 20-24 years.
The rate of preterm births increases in pregnancies in which the mother is older than 40 years. The scoring system for the risk of preterm delivery uses a criterion of age older than 40 years.
Maternal marijuana use appears to be associated with an increased risk of neonatal morbidity (eg, infection and neurologic morbidity) or death. 
In the general population, an estimated 12% of infants are born prematurely, and about 50% of preterm births are preceded by preterm labor. 
No reliable international numbers are available, because different countries use different definitions of birth (eg, survival after birth, survival after 1 month).
Premature infants are born to women of every race. Extremely low birth weight (ELBW) infants are most commonly born to women of low socioeconomic status, black women, teenage females, and women older than 40 years. Women at highest risk of premature delivery can be assessed by using a scoring system that reviews their socioeconomic status, history, daily habits, and current pregnancy events.  About 30% of women with a high-risk score deliver prematurely compared to 2.5% of women with a low-risk score.
Primarily because of the increased incidence of preterm infants, the overall neonatal mortality rate in black populations in the United States is 2.3 times that of white populations. Improvements in socioeconomic status and perinatal care have not improved the rate of prematurity and infant mortality rate in this population.
The results from a study (N = 2549 neonates) noted that male infants born prematurely have a higher risk of grade III/IV intraventricular hemorrhage, sepsis, and major surgery than premature females. A greater risk of mortality and poorer long-term neurologic outcome were also noted; however, sex-related differences for these appeared to lose significance at 27 weeks’ gestation. 
Female sex is associated with increased rates of survival of newborns born at 22-25 weeks’ gestation.
Mortality and morbidity are inversely proportional to gestational age and birth weight. Infants with extremely low birth weight (ELBW) who are born at tertiary care centers have outcomes more favorable than those who are born at level I or II centers and then transferred.
Roberts et al found that children born at 22-27 weeks’ gestation have high rates of adverse neurodevelopmental outcome at age 8 years.  Assessment of a regional cohort of 144 survivors of preterm birth showed that, relative to matched term controls, the preterm cohort had substantially higher rates of blindness, deafness, cerebral palsy, and intellectual impairment and disabilities caused by these impairments. Comparison of preterm children born in 1997 with those born in 1991-1992 showed that the rates of moderate or severe disability were similar in the two cohorts (19%), but the rate of mild impairment was greater in 1997 (40% vs 24%); disability rates in control groups showed virtually no change over time. 
Infants born at born at 23-25 weeks of gestation who receive antenatal exposure to corticosteroids appear to have a lower rate of mortality and complications compared with those who do not have such exposure.  Infants born at at 34-36 weeks’ gestation with antenatal exposure to corticosteroids between 24 and 34 weeks of gestation also appear to have a lower incidence of respiratory disorders. 
Preterm births account for approximately 70% of neonatal deaths and 36% of infant deaths, as well as 25-50% of cases of long-term neurologic impairment in children. 
The mortality rate is high in developing countries, especially those of Sub-Saharan Africa. The perinatal mortality rate is 70 deaths per 1000 births; the neonatal mortality rate is 45 deaths per 1000 live births. Preterm birth is the strongest independent predictor of mortality in the United States. Preterm delivery accounts for 75-80% of all neonatal morbidity and mortality.
Since the early 1960s, survival rates of premature infants substantially increased because of technologic advances. From 1989-1990, infants with birth weights less than 751 g had a survival rate of 39% (range among centers, 23-48%). In 1992, the US Food and Drug Administration (FDA) approved exogenous surfactant therapy for respiratory distress syndrome (RDS), leading to a considerable improvement in survival rates. Since the FDA approved the use of surfactant and since the subsequent introduction of numerous natural surfactants, the mortality rate attributed to surfactant deficiency has been markedly reduced. See Acute Respiratory Distress Syndrome.
Data from the Vermont Oxford Network in 1994-1996 indicated that the survival rate of infants born weighing less than 1000 g was 74.9%.  Survival of infants born weighing less than 1000 g and requiring cardiopulmonary resuscitation in the delivery room was substantially decreased (53.8%). The changes in obstetric and neonatal care in the first half of the decade of 1990s decreased mortality and morbidity for ELBW infants. No additional improvements in mortality and morbidity were observed at the end of the decade.
Obstetric and pediatric personnel must be familiar with their own institutional data in addition to national benchmarks related to gestational age and mortality rates. These data are essential for proper prenatal counseling of parents and/or caregivers regarding survival and resuscitation plans.
The three primary causes of mortality in infants born with a weight of less than 1000 g are respiratory failure, infection, and congenital malformation. Infection of the amniotic fluid leading to pneumonia is the major cause of mortality.  In infants who weigh less than 500 g at birth, immaturity is listed as the only cause of mortality. See Ethical Issues in Neonatal Care.
Women who have an intrauterine infection do not respond to tocolytics. Preterm premature rupture of membranes (PPROM) is associated with 30-40% of premature deliveries. See Premature Rupture of Membranes. Mortality of the premature infant increases with coexisting PPROM but depends on gestational age and the expertise of the maternal-fetal monitoring team. Postnatal findings of periventricular leukomalacia (PVL) on cranial ultrasonography are highly correlated with chorioamnionitis.
In premature infants with a congenital heart defect (CHD), excluding isolated patent ductus arteriosus, the actuarial survival rate is 51% at 10 years, whereas infants with both CHD and prematurity have substantially worsened outcomes than infants who only have one of these conditions.  The survival rate improved as the study period (1976-1999) progressed. Congenital anomalies are an independent risk factor for mortality and morbidity in preterm birth.
In a longitudinal study of 1279 extremely premature children, (gestational age ≤28 week; birth weight 24</ref> Among affected children, hearing loss was delayed in onset in 10% and progressive in 28%. Prolonged supplemental oxygen use was the most important marker for predicting hearing loss.
In a retrospective analysis of data from 20,231 live births recorded between 1995 and 2003, Werner et al found that very premature infants who are delivered vaginally have fewer breathing problems than do those delivered by cesarean section. [25, 26] All of the study’s infants were born after 24-34 weeks’ gestation, with 69.3% of them delivered vaginally. In comparison with the vaginally delivered infants, those delivered by cesarean section were more likely to be born in respiratory distress (39.2% compared with 25.6% for vaginal delivery). Infants in the study who underwent cesarean delivery were also more likely than vaginally delivered infants to have a 5-minute Apgar score of less than 7 (10.7% vs 5.8%, respectively). [25, 26]
Communicate clearly to the expectant parents regarding potential adverse outcomes. Clear up any inappropriate expectations on the part of the family. The smallest and most immature infants are at greatest risk of adverse neurodevelopmental outcomes.
Discharge teaching of caretakers of the premature infant includes the following:
American College of Obstetricians and Gynecologists. Practice bulletin no. 159: Management of preterm labor. Obstet Gynecol. 2016 Jan. 127 (1):e29-38. [Medline].
Ballard JL, Khoury JC, Wedig K, Wang L, Eilers-Walsman BL, Lipp R. New Ballard Score, expanded to include extremely premature infants. J Pediatr. 1991 Sep. 119 (3):417-23. [Medline].
World Health Organization. Safe Motherhood. Thermal Protection of the Newborn: A Practical Guide. Geneva, Switzerland: World Health Organization; 1997. [Full Text].
Stritzke A, Thomas S, Amin H, Fusch C, Lodha A. Renal consequences of preterm birth. Mol Cell Pediatr. 2017 Dec. 4 (1):2. [Medline].
Rudge MV, Calderon IM, Ramos MD, Abbade JF, Rugolo LM. Perinatal outcome of pregnancies complicated by diabetes and by maternal daily hyperglycemia not related to diabetes. A retrospective 10-year analysis. Gynecol Obstet Invest. 2000. 50 (2):108-12. [Medline].
Sibai BM, Caritis S, Hauth J, Lindheimer M, VanDorsten JP, MacPherson C, et al. Risks of preeclampsia and adverse neonatal outcomes among women with pregestational diabetes mellitus. National Institute of Child Health and Human Development Network of Maternal-Fetal Medicine Units. Am J Obstet Gynecol. 2000 Feb. 182 (2):364-9. [Medline].
Kogan MD, Alexander GR, Kotelchuck M, et al. Trends in twin birth outcomes and prenatal care utilization in the United States, 1981-1997. JAMA. 2000 Jul 19. 284 (3):335-41. [Medline].
Fritz MA. Infertility treatment and the multifetal gestation epidemic: too much of a good thing. Contemporary OB-GYN. Available at http://contemporaryobgyn.modernmedicine.com/contemporary-obgyn/news/clinical/obstetrics-gynecology-womens-health/infertility-treatment-and-multi. September 1, 2002; Accessed: July 1, 2015.
Boulet SL, Schieve LA, Nannini A, et al. Perinatal outcomes of twin births conceived using assisted reproduction technology: a population-based study. Hum Reprod. 2008 Aug. 23 (8):1941-8. [Medline].
Ziadeh SM. The outcome of triplet versus twin pregnancies. Gynecol Obstet Invest. 2000. 50 (2):96-9. [Medline].
Olausson PO, Cnattingius S, Haglund B. Teenage pregnancies and risk of late fetal death and infant mortality. Br J Obstet Gynaecol. 1999 Feb. 106 (2):116-21. [Medline].
Andres RL, Day MC. Perinatal complications associated with maternal tobacco use. Semin Neonatol. 2000 Aug. 5 (3):231-41. [Medline].
Suzuki K, Tanaka T, Kondo N, Minai J, Sato M, Yamagata Z. Is maternal smoking during early pregnancy a risk factor for all low birth weight infants?. J Epidemiol. 2008. 18 (3):89-96. [Medline].
Metz TD, Allshouse AA, Hogue CJ, et al. Maternal marijuana use, adverse pregnancy outcomes, and neonatal morbidity. Am J Obstet Gynecol. 2017 Oct. 217 (4):478.e1-478.e8. [Medline].
Creasy RK, Gummer BA, Liggins GC. System for predicting spontaneous preterm birth. Obstet Gynecol. 1980 Jun. 55 (6):692-5. [Medline].
Kent AL, Wright IM, Abdel-Latif ME, for the New South Wales and Australian Capital Territory Neonatal Intensive Care Units Audit Group. Mortality and adverse neurologic outcomes are greater in preterm male infants. Pediatrics. 2012 Jan. 129 (1):124-31. [Medline].
Roberts G, Anderson PJ, De Luca C, Doyle LW, for the Victorian Infant Collaborative Study Group. Changes in neurodevelopmental outcome at age eight in geographic cohorts of children born at 22-27 weeks’ gestational age during the 1990s. Arch Dis Child Fetal Neonatal Ed. 2010 Mar. 95 (2):F90-4. [Medline].
Carlo WA, McDonald SA, Fanaroff AA, et al, for the Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Association of antenatal corticosteroids with mortality and neurodevelopmental outcomes among infants born at 22 to 25 weeks’ gestation. JAMA. 2011 Dec 7. 306 (21):2348-58. [Medline].
Ventolini G, Neiger R, Mathews L, Adragna N, Belcastro M. Incidence of respiratory disorders in neonates born between 34 and 36 weeks of gestation following exposure to antenatal corticosteroids between 24 and 34 weeks of gestation. Am J Perinatol. 2008 Feb. 25 (2):79-83. [Medline].
Finer NN, Horbar JD, Carpenter JH. Cardiopulmonary resuscitation in the very low birth weight infant: the Vermont Oxford Network experience. Pediatrics. 1999 Sep. 104 (3 pt 1):428-34. [Medline].
Barton L, Hodgman JE, Pavlova Z. Causes of death in the extremely low birth weight infant. Pediatrics. 1999 Feb. 103 (2):446-51. [Medline].
Dees E, Lin H, Cotton RB, Graham TP, Dodd DA. Outcome of preterm infants with congenital heart disease. J Pediatr. 2000 Nov. 137 (5):653-9. [Medline].
Robertson CM, Howarth TM, Bork DL, Dinu IA. Permanent bilateral sensory and neural hearing loss of children after neonatal intensive care because of extreme prematurity: a thirty-year study. Pediatrics. 2009 May. 123 (5):e797-807. [Medline].
Werner EF, Han CS, Savitz DA, Goldshore M, Lipkind HS. Health outcomes for vaginal compared with cesarean delivery of appropriately grown preterm neonates. Obstet Gynecol. 2013 Jun. 121 (6):1195-200. [Medline].
Pittman G. Vaginal delivery safer for many preemies: study. Reuters Health Information. Available at http://www.medscape.com/viewarticle/803871. May 8, 2013; Accessed: June 5, 2013.
Dubowitz LM, Dubowitz V, Goldberg C. Clinical assessment of gestational age in the newborn infant. J Pediatr. 1970 Jul. 77 (1):1-10. [Medline].
Hittner HM, Hirsch NJ, Rudolph AJ. Assessment of gestational age by examination of the anterior vascular capsule of the lens. J Pediatr. 1977 Sep. 91 (3):455-8. [Medline].
Conde-Agudelo A, Romero R. Cervical phosphorylated insulin-like growth factor binding protein-1 test for the prediction of preterm birth: a systematic review and metaanalysis. Am J Obstet Gynecol. 2016 Jan. 214 (1):57-73. [Medline].
Conde-Agudelo A, Romero R. Predictive accuracy of changes in transvaginal sonographic cervical length over time for preterm birth: a systematic review and metaanalysis. Am J Obstet Gynecol. 2015 Dec. 213 (6):789-801. [Medline].
Hummler H, Fuchs H, Schmid M. Automated adjustments of inspired fraction of oxygen to avoid hypoxemia and hyperoxemia in neonates – a systematic review on clinical studies. Klin Padiatr. 2014 Jul. 226 (4):204-10. [Medline].
Waitz M, Schmid MB, Fuchs H, Mendler MR, Dreyhaupt J, Hummler HD. Effects of automated adjustment of the inspired oxygen on fluctuations of arterial and regional cerebral tissue oxygenation in preterm infants with frequent desaturations. J Pediatr. 2015 Feb. 166 (2):240-4.e1. [Medline].
van Kaam AH, Hummler HD, Wilinska M, et al. Automated versus manual oxygen control with different saturation targets and modes of respiratory support in preterm infants. J Pediatr. 2015 Sep. 167 (3):545-50.e1-2. [Medline].
Van Zanten HA, Kuypers KLAM, Stenson BJ, Bachman TE, Pauws SC, Te Pas AB. The effect of implementing an automated oxygen control on oxygen saturation in preterm infants. Arch Dis Child Fetal Neonatal Ed. 2017 Sep. 102 (5):F395-9. [Medline].
Lal M, Tin W, Sinha S. Automated control of inspired oxygen in ventilated preterm infants: crossover physiological study. Acta Paediatr. 2015 Nov. 104 (11):1084-9. [Medline].
Dargaville PA, Sadeghi Fathabadi O, et al. Development and preclinical testing of an adaptive algorithm for automated control of inspired oxygen in the preterm infant. Arch Dis Child Fetal Neonatal Ed. 2017 Jan. 102 (1):F31-6. [Medline].
Plottier GK, Wheeler KI, Ali SK, et al. Clinical evaluation of a novel adaptive algorithm for automated control of oxygen therapy in preterm infants on non-invasive respiratory support. Arch Dis Child Fetal Neonatal Ed. 2017 Jan. 102 (1):F37-F43. [Medline].
Fuchs H, Lindner W, Leiprecht A, Mendler MR, Hummler HD. Predictors of early nasal CPAP failure and effects of various intubation criteria on the rate of mechanical ventilation in preterm infants of Arch Dis Child Fetal Neonatal Ed</i>. 2011 Sep. 96 (5):F343-7. [Medline].
Manley BJ, Owen LS, Doyle LW, et al. High-flow nasal cannulae in very preterm infants after extubation. N Engl J Med. Oct 10 2013. 369(15):1425-33. [Medline].
Fox S. AAP backs CPAP plus selective surfactants in premies. Medscape Medical News. Available at http://www.medscape.com/viewarticle/818416. December 30, 2013; Accessed: January 5, 2014.
DeMauro SB, Douglas E, Karp K, et al. Improving delivery room management for very preterm infants. Pediatrics. 2013 Oct. 132 (4):e1018-25. [Medline].
Fox S. Delivery room guidelines improve outcomes for preemies. Medscape Medical News. Available at http://www.medscape.com/viewarticle/811032. September 16, 2013; Accessed: September 23, 2013.
Engmann C, Wall S, Darmstadt G, Valsangkar B, Claeson M, for the participants of the Istanbul KMC Acceleration Meeting. Consensus on kangaroo mother care acceleration. Lancet. 2013 Nov 30. 382 (9907):e26-7. [Medline].
Eliakim A, Litmanovitz I, Nemet D. The role of exercise in prevention and treatment of osteopenia of prematurity: an update. Pediatr Exerc Sci. 2017 Oct 10. 1-6. [Medline].
Capone K, Sriram S, Patton T, et al. Effects of chromium on glucose tolerance in infants receiving parenteral nutrition therapy. Nutr Clin Pract. 2017 Jun 1. 884533617711162. [Medline].
Kapoor V, Glover R, Malviya MN. Alternative lipid emulsions versus pure soy oil based lipid emulsions for parenterally fed preterm infants. Cochrane Database Syst Rev. 2015 Dec 2. 12:CD009172. [Medline].
Abrams SA, for the American Academy of Pediatrics Committee on Nutrition. Calcium and vitamin d requirements of enterally fed preterm infants. Pediatrics. 2013 May. 131 (5):e1676-83. [Medline].
Hand L. Guidelines: Preterm infants require vitamin D supplement. Medscape Medical News. Available at http://www.medscape.com/viewarticle/803253. April 29, 2013; Accessed: May 9, 2013.
Ohls RK, Christensen RD, Kamath-Rayne BD, et al. A randomized, masked, placebo-controlled study of darbepoetin alfa in preterm infants. Pediatrics. 2013 Jul. 132 (1):e119-27. [Medline].
Hand L. Darbepoetin reduces transfusion needs in preterm infants. Medscape Medical News. Available at http://www.medscape.com/viewarticle/806369. June 17, 2013; Accessed: June 24, 2013.
Von Kohorn I, Ehrenkranz RA. Anemia in the preterm infant: erythropoietin versus erythrocyte transfusion–it’s not that simple. Clin Perinatol. 2009 Mar. 36 (1):111-23. [Medline].
Allen MC, Alexander GR, Tompkins ME, Hulsey TC. Racial differences in temporal changes in newborn viability and survival by gestational age. Paediatr Perinat Epidemiol. 2000 Apr. 14 (2):152-8. [Medline].
Alme AM, Mulhern ML, Hejkal TW, et al. Outcome of retinopathy of prematurity patients following adoption of revised indications for treatment. BMC Ophthalmol. 2008 Nov 13. 8:23. [Medline].
Anand KJ, Hall RW, Desai N, et al, for the NEOPAIN Trial Investigators Group. Effects of morphine analgesia in ventilated preterm neonates: primary outcomes from the NEOPAIN randomised trial. Lancet. 2004 May 22. 363 (9422):1673-82. [Medline].
Barrington KJ, Finer NN. Inhaled nitric oxide for respiratory failure in preterm infants. Cochrane Database Syst Rev. 2006 Jan 25. 25:CD000509. [Medline].
Beckerman KP. Protease inhibitor treatment of HIV-1-infected women may protect against extreme prematurity and very low birth weight. J Infect Dis. 2007 Oct 15. 196 (8):1270-1; author reply 1271. [Medline].
Bell EF. Preventing necrotizing enterocolitis: what works and how safe?. Pediatrics. 2005 Jan. 115 (1):173-4. [Medline].
Bell EF. When to transfuse preterm babies. Arch Dis Child Fetal Neonatal Ed. 2008 Nov. 93 (6):F469-73. [Medline].
Bernstein IM, Horbar JD, Badger GJ, Ohlsson A, Golan A. Morbidity and mortality among very-low-birth-weight neonates with intrauterine growth restriction. The Vermont Oxford Network. Am J Obstet Gynecol. 2000 Jan. 182 (1 pt 1):198-206. [Medline].
Bhandari V, Bergqvist LL, Kronsberg SS, Barton BA, Anand KJ, for the NEOPAIN Trial Investigators Group. Morphine administration and short-term pulmonary outcomes among ventilated preterm infants. Pediatrics. 2005 Aug. 116 (2):352-9. [Medline].
Borna S, Saeidi FM. Celecoxib versus magnesium sulfate to arrest preterm labor: randomized trial. J Obstet Gynaecol Res. 2007 Oct. 33 (5):631-4. [Medline].
Chiswick M. Infants of borderline viability: ethical and clinical considerations. Semin Fetal Neonatal Med. 2008 Feb. 13 (1):8-15. [Medline].
Clarke P, Mitchell SJ, Wynn R, et al. Vitamin K prophylaxis for preterm infants: a randomized, controlled trial of 3 regimens. Pediatrics. 2006 Dec. 118 (6):e1657-66. [Medline].
Cole CH. Prevention of prematurity: can we do it in America?. Pediatrics. 1985 Aug. 76 (2):310-2. [Medline].
Cotter AM, Garcia AG, Duthely ML, Luke B, O’Sullivan MJ. Is antiretroviral therapy during pregnancy associated with an increased risk of preterm delivery, low birth weight, or stillbirth?. J Infect Dis. 2006 May 1. 193 (9):1195-201. [Medline].
Crowther CA, Haslam RR, Hiller JE, Doyle LW, Robinson JS, for the Australasian Collaborative Trial of Repeat Doses of Steroids (ACTORDS) Study Group. Neonatal respiratory distress syndrome after repeat exposure to antenatal corticosteroids: a randomised controlled trial. Lancet. 2006 Jun 10. 367 (9526):1913-9. [Medline].
Doron MW, Veness-Meehan KA, Margolis LH, Holoman EM, Stiles AD. Delivery room resuscitation decisions for extremely premature infants. Pediatrics. 1998 Sep. 102 (3 pt 1):574-82. [Medline].
Doyle LW, Davis PG, Morley CJ, McPhee A, Carlin JB, for the DART Study Investigators. Outcome at 2 years of age of infants from the DART study: a multicenter, international, randomized, controlled trial of low-dose dexamethasone. Pediatrics. 2007 Apr. 119 (4):716-21. [Medline].
Doyle LW, Halliday HL, Ehrenkranz RA, Davis PG, Sinclair JC. Impact of postnatal systemic corticosteroids on mortality and cerebral palsy in preterm infants: effect modification by risk for chronic lung disease. Pediatrics. 2005 Mar. 115 (3):655-61. [Medline].
Durnwald CP, Walker H, Lundy JC, Iams JD. Rates of recurrent preterm birth by obstetrical history and cervical length. Am J Obstet Gynecol. 2005 Sep. 193 (3 pt 2):1170-4. [Medline].
El-Metwally D, Vohr B, Tucker R. Survival and neonatal morbidity at the limits of viability in the mid 1990s: 22 to 25 weeks. J Pediatr. 2000 Nov. 137 (5):616-22. [Medline].
Escobar GJ, Clark RH, Greene JD. Short-term outcomes of infants born at 35 and 36 weeks’ gestation: we need to ask more questions. Semin Perinatol. 2006 Feb. 30 (1):28-33. [Medline].
Fanaroff AA, Stoll BJ, Wright LL, et al, for the NICHD Neonatal Research Network. Trends in neonatal morbidity and mortality for very low birthweight infants. Am J Obstet Gynecol. 2007 Feb. 196 (2):147.e1-8. [Medline].
Foix-L’Helias L, Marret S, Ancel PY, et al, for the EPIPAGE Study Group. Impact of the use of antenatal corticosteroids on mortality, cerebral lesions and 5-year neurodevelopmental outcomes of very preterm infants: the EPIPAGE cohort study. BJOG. 2008 Jan. 115 (2):275-82. [Medline].
Furdon SA, Lapitsky J, Diven S, Horgan MJ. Effect of standardized approach to the care of the extremely low birthweight infant. J Nurs Care Qual. 1997 Aug. 11 (6):42-51. [Medline].
Gracey K, Talbot D, Lankford R, Dodge P. Family teaching toolbox. Nasal cannula home oxygen. Adv Neonatal Care. 2003 Apr. 3 (2):99-101. [Medline].
Groh-Wargo S, Hovasi Cox J, Thompson M. Nutritional Care for High-Risk Newborns. 3rd ed. Los Angeles, CA: Taylor Trade Publishing; 2000.
Gross SJ, Anbar RD, Mettelman BB. Follow-up at 15 years of preterm infants from a controlled trial of moderately early dexamethasone for the prevention of chronic lung disease. Pediatrics. 2005 Mar. 115 (3):681-7. [Medline].
Hallenberger A, Poets CF, Horn W, Seyfang A, Urschitz MS, for the CLAC Study Group. Closed-loop automatic oxygen control (CLAC) in preterm infants: a randomized controlled trial. Pediatrics. 2014 Feb. 133 (2):e379-85. [Medline].
Halliday HL, Ehrenkranz RA, Doyle LW. Early (Cochrane Database Syst Rev</i>. 2009 Jan 21. 21:CD001146. [Medline].
Hellgren K, Hellstrom A, Jacobson L, Flodmark O, Wadsby M, Martin L. Visual and cerebral sequelae of very low birth weight in adolescents. Arch Dis Child Fetal Neonatal Ed. 2007 Jul. 92 (4):F259-64. [Medline].
Hodnett ED, Fredericks S, Weston J. Support during pregnancy for women at increased risk of low birthweight babies. Cochrane Database Syst Rev. 2010 Jun 16. 8 (6):CD000198. [Medline].
Holditch-Davis D, Merrill P, Schwartz T, Scher M. Predictors of wheezing in prematurely born children. J Obstet Gynecol Neonatal Nurs. 2008 May-Jun. 37 (3):262-73. [Medline].
Horbar JD, Badger GJ, Carpenter JH, et al, for the Members of the Vermont Oxford Network. Trends in mortality and morbidity for very low birth weight infants, 1991-1999. Pediatrics. 2002 Jul. 110 (1 pt 1):143-51. [Medline].
Huxley R, Owen CG, Whincup PH, et al. Is birth weight a risk factor for ischemic heart disease in later life?. Am J Clin Nutr. 2007 May. 85 (5):1244-50. [Medline].
Johnston CC, Stevens B, Pinelli J, et al. Kangaroo care is effective in diminishing pain response in preterm neonates. Arch Pediatr Adolesc Med. 2003 Nov. 157 (11):1084-8. [Medline].
Juul SE, McPherson RJ, Bauer LA, Ledbetter KJ, Gleason CA, Mayock DE. A phase I/II trial of high-dose erythropoietin in extremely low birth weight infants: pharmacokinetics and safety. Pediatrics. 2008 Aug. 122 (2):383-91. [Medline].
Klaus MH, Fanaroff AA. Care of the High-Risk Neonate. 5th ed. Philadelphia, PA: WB Saunders; 2001.
Kraybill EN. Ethical issues in the care of extremely low birth weight infants. Semin Perinatol. 1998 Jun. 22 (3):207-15. [Medline].
Kulmala T, Vaahtera M, Ndekha M, et al. The importance of preterm births for peri- and neonatal mortality in rural Malawi. Paediatr Perinat Epidemiol. 2000 Jul. 14 (3):219-26. [Medline].
Larsson PG, Fahraeus L, Carlsson B, Jakobsson T, Forsum U, for the Premature Study Group of the Southeast Health Care Region of Sweden. Late miscarriage and preterm birth after treatment with clindamycin: a randomised consent design study according to Zelen. BJOG. 2006 Jun. 113 (6):629-37. [Medline].
Lin HC, Su BH, Chen AC, et al. Oral probiotics reduce the incidence and severity of necrotizing enterocolitis in very low birth weight infants. Pediatrics. 2005 Jan. 115 (1):1-4. [Medline].
Lindstrom K, Winbladh B, Haglund B, Hjern A. Preterm infants as young adults: a Swedish national cohort study. Pediatrics. 2007 Jul. 120 (1):70-7. [Medline].
Linhart Y, Bashiri A, Maymon E, et al. Congenital anomalies are an independent risk factor for neonatal morbidity and perinatal mortality in preterm birth. Eur J Obstet Gynecol Reprod Biol. 2000 May. 90 (1):43-9. [Medline].
Lund C, Kuller J, Lane A, Lott JW, Raines DA. Neonatal skin care: the scientific basis for practice. Neonatal Netw. 1999 Jun. 18 (4):15-27. [Medline].
Maguire CM, Veen S, Sprij AJ, Le Cessie S, Wit JM, Walther FJ, et al. Effects of basic developmental care on neonatal morbidity, neuromotor development, and growth at term age of infants who were born at Pediatrics</i>. 2008 Feb. 121 (2):e239-45. [Medline].
Mahomed K, Bhutta Z, Middleton P. Zinc supplementation for improving pregnancy and infant outcome. Cochrane Database Syst Rev. 2007 Apr 18. 2:CD000230. [Medline].
Malloy MH, Freeman DH. Respiratory distress syndrome mortality in the United States, 1987 to 1995. J Perinatol. 2000 Oct-Nov. 20 (7):414-20. [Medline].
Biniwale M, Weiner A, Sardesai S, Cayabyab R, Barton L, Ramanathan R. Early postnatal weight gain as a predictor for the development of retinopathy of prematurity. J Matern Fetal Neonatal Med. 2017 Oct 1. 1-5. [Medline].
Marret S, Marpeau L, Zupan-Simunek V, Eurin D, Leveque C, Hellot MF, et al. Magnesium sulphate given before very-preterm birth to protect infant brain: the randomised controlled PREMAG trial*. BJOG. 2007 Mar. 114 (3):310-8. [Medline].
Martin JA, Hamilton BE, Osterman MJ, Driscoll AK, Mathews TJ. Births: Final Data for 2015. Natl Vital Stat Rep. 2017 Jan. 66 (1):1. [Medline].
Murphy SL, Mathews TJ, Martin JA, Minkovitz CS, Strobino DM. Annual summary of vital statistics: 2013-2014. Pediatrics. 2017 Jun. 139 (6):788-801. [Medline].
McCall EM, Alderdice FA, Halliday HL, Jenkins JG, Vohra S. Interventions to prevent hypothermia at birth in preterm and/or low birthweight infants. Cochrane Database Syst Rev. 2008 Jan 23. 1:CD004210. [Medline].
Camp M, Chang DC, Zhang Y, et al. Provider density and health system facility factors and their relationship to rates of pediatric perforated appendicitis in US counties. Arch Surg. 2010 Dec. 145 (12):1139-44. [Medline].
Mercer B, Milluzzi C, Collin M. Periviable birth at 20 to 26 weeks of gestation: proximate causes, previous obstetric history and recurrence risk. Am J Obstet Gynecol. 2005 Sep. 193 (3 pt 2):1175-80. [Medline].
Mestan KK, Marks JD, Hecox K, Huo D, Schreiber MD. Neurodevelopmental outcomes of premature infants treated with inhaled nitric oxide. N Engl J Med. 2005 Jul 7. 353 (1):23-32. [Medline].
Moore ML. Preterm labor and birth: what have we learned in the past two decades?. J Obstet Gynecol Neonatal Nurs. 2003 Sep-Oct. 32 (5):638-49. [Medline].
Murakami Y, Jain A, Silva RA, Lad EM, Gandhi J, Moshfeghi DM. Stanford University Network for Diagnosis of Retinopathy of Prematurity (SUNDROP): 12-month experience with telemedicine screening. Br J Ophthalmol. 2008 Nov. 92 (11):1456-60. [Medline].
Ohlsson A, Aher SM. Early erythropoietin for preventing red blood cell transfusion in preterm and/or low birth weight infants. Cochrane Database Syst Rev. 2006 Jul 19. 19:CD004863. [Medline].
Osborn DA, Evans N. Early volume expansion for prevention of morbidity and mortality in very preterm infants. Cochrane Database Syst Rev. 2004. 2:CD002055. [Medline].
Peltoniemi OM, Kari MA, Tammela O, et al, for the Repeat Antenatal Betamethasone Study Group. Randomized trial of a single repeat dose of prenatal betamethasone treatment in imminent preterm birth. Pediatrics. 2007 Feb. 119 (2):290-8. [Medline].
Pool V, Iskander J. Safety of influenza vaccination during pregnancy. Am J Obstet Gynecol. 2006 Apr. 194 (4):1200; author reply 1201. [Medline].
Rautava L, Lehtonen L, Peltola M, et al, for the PERFECT Preterm Infant Study Group. The effect of birth in secondary- or tertiary-level hospitals in Finland on mortality in very preterm infants: a birth-register study. Pediatrics. 2007 Jan. 119 (1):e257-63. [Medline].
Raydo LJ, Reu-Donlon CM. Putting babies “back to sleep”: can we do better?. Neonatal Netw. 2005 Nov-Dec. 24 (6):9-16. [Medline].
Robertson CM, Watt MJ, Yasui Y. Changes in the prevalence of cerebral palsy for children born very prematurely within a population-based program over 30 years. JAMA. 2007 Jun 27. 297 (24):2733-40. [Medline].
Romero R. Prevention of spontaneous preterm birth: the role of sonographic cervical length in identifying patients who may benefit from progesterone treatment. Ultrasound Obstet Gynecol. 2007 Oct. 30 (5):675-86. [Medline].
Schieve LA, Cohen B, Nannini A, et al, for the Massachusetts Consortium for Assisted Reproductive Technology Epidemiologic Research (MCARTER). A population-based study of maternal and perinatal outcomes associated with assisted reproductive technology in Massachusetts. Matern Child Health J. 2007 Nov. 11 (6):517-25. [Medline].
Schreiber MD, Gin-Mestan K, Marks JD, Huo D, Lee G, Srisuparp P. Inhaled nitric oxide in premature infants with the respiratory distress syndrome. N Engl J Med. 2003 Nov 27. 349 (22):2099-107. [Medline].
Schulte J, Dominguez K, Sukalac T, Bohannon B, Fowler MG, for the Pediatric Spectrum of HIV Disease Consortium. Declines in low birth weight and preterm birth among infants who were born to HIV-infected women during an era of increased use of maternal antiretroviral drugs: Pediatric Spectrum of HIV Disease, 1989-2004. Pediatrics. 2007 Apr. 119 (4):e900-6. [Medline].
Simoes EA, Groothuis JR, Carbonell-Estrany X, et al, for the Palivizumab Long-Term Respiratory Outcomes Study Group. Palivizumab prophylaxis, respiratory syncytial virus, and subsequent recurrent wheezing. J Pediatr. 2007 Jul. 151 (1):34-42, 42.e1. [Medline].
Smith GN, Walker MC, Ohlsson A, O’Brien K, Windrim R, for the Canadian Preterm Labour Nitroglycerin Trial Group. Randomized double-blind placebo-controlled trial of transdermal nitroglycerin for preterm labor. Am J Obstet Gynecol. 2007 Jan. 196 (1):37.e1-8. [Medline].
Stevens B, Yamada J, Ohlsson A. Sucrose for analgesia in newborn infants undergoing painful procedures. Cochrane Database Syst Rev. 2004. 3:CD001069. [Medline].
Stupin JH, David M, Siedentopf JP, Dudenhausen JW. Emergency cerclage versus bed rest for amniotic sac prolapse before 27 gestational weeks. A retrospective, comparative study of 161 women. Eur J Obstet Gynecol Reprod Biol. 2008 Jul. 139 (1):32-7. [Medline].
Tyson JE, Kennedy KA. Trophic feedings for parenterally fed infants. Cochrane Database Syst Rev. 2005 Jul 20. 3:CD000504. [Medline].
van Wassenaer AG, Westera J, Houtzager BA, Kok JH. Ten-year follow-up of children born at Pediatrics</i>. 2005 Nov. 116 (5):e613-8. [Medline].
Ventolini G, Neiger R, Hood DL, Belcastro MR. 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. 2006 May. 26 (5):264-7. [Medline].
Westrup B, Bohm B, Lagercrantz H, Stjernqvist K. Preschool outcome in children born very prematurely and cared for according to the Newborn Individualized Developmental Care and Assessment Program (NIDCAP). Acta Paediatr. 2004 Apr. 93 (4):498-507. [Medline].
Wright VC, Schieve LA, Reynolds MA, Jeng G, Kissin D. Assisted reproductive technology surveillance–United States, 2001. MMWR Surveill Summ. 2004 Apr 30. 53 (1):1-20. [Medline].
Stone WL, Shah D, Hollinger SM. Retinopathy of prematurity: an oxidative stress neonatal disease. Front Biosci (Landmark Ed). 2016 Jan 1. 21:165-77. [Medline].
Ross GS, Foran LM, Barbot B, Sossin KM, Perlman JM. Using cluster analysis to provide new insights into development of very low birthweight (VLBW) premature infants. Early Hum Dev. 2016 Jan. 92:45-9. [Medline].
Sharma D. Golden 60 minutes of newborn’s life: Part 1: Preterm neonate. J Matern Fetal Neonatal Med. 2017 Nov. 30 (22):2716-27. [Medline].
Susan A Furdon, RNC, NNP-BC, MS Neonatal Clinical Nurse Specialist/Nurse Practitioner, Department of Pediatrics, Albany Medical Center
Disclosure: Nothing to disclose.
David A Clark, MD Professor and Martha Lepow Chairman of Pediatrics, Professor of Obstetrics and Gynecology, Albany Medical College; Director, Children’s Hospital at Albany Medical Center
David A Clark, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Pediatrics, American College of Nutrition, American Forestry Association, American Pediatric Society, Capital District Pediatric Society, Christian Medical and Dental Associations, European Society for Paediatric Research, Eastern Society for Pediatric Research, Floyd W Denny Pediatric Alumni Society, Medical Society of the State of New York, New York Academy of Sciences, Society for Pediatric Research
Disclosure: Nothing to disclose.
Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference
Disclosure: Nothing to disclose.
Arun K Pramanik, MD, MBBS Professor of Pediatrics, Louisiana State University Health Sciences Center
Arun K Pramanik, MD, MBBS is a member of the following medical societies: American Academy of Pediatrics, American Thoracic Society, National Perinatal Association, Southern Society for Pediatric Research
Disclosure: Nothing to disclose.
Dharmendra J Nimavat, MD, FAAP Associate Professor of Clinical Pediatrics, Department of Pediatrics, Division of Neonatology, Southern Illinois University School of Medicine; Staff Neonatologist, Clinical Director, NICU Regional Perinatal Center, HSHS St John’s Children’s Hospital
Dharmendra J Nimavat, MD, FAAP is a member of the following medical societies: American Academy of Pediatrics, American Association of Physicians of Indian Origin
Disclosure: Nothing to disclose.
Ted Rosenkrantz, MD Professor, Departments of Pediatrics and Obstetrics/Gynecology, Division of Neonatal-Perinatal Medicine, University of Connecticut School of Medicine
Ted Rosenkrantz, MD is a member of the following medical societies: American Academy of Pediatrics, American Pediatric Society, Eastern Society for Pediatric Research, American Medical Association, Connecticut State Medical Society, Society for Pediatric Research
Disclosure: Nothing to disclose.
Research & References of Prematurity|A&C Accounting And Tax Services