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Discover Pediatric Collections on COVID-19 and Racism and Its Effects on Pediatric Health

American Academy of Pediatrics
State-of-the-Art Review Article

Late Preterm Infants: Near Term But Still in a Critical Developmental Time Period

Amir Kugelman and Andrew A. Colin
Pediatrics October 2013, 132 (4) 741-751; DOI: https://doi.org/10.1542/peds.2013-1131
Amir Kugelman
aDepartment of Neonatology and Pediatric Pulmonary Unit, Bnai Zion Medical Center, The B&R Rappaport Faculty of Medicine, Technion, Haifa, Israel; and
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Andrew A. Colin
bDivision of Pediatric Pulmonology, Miller School of Medicine, University of Miami, Miami, Florida
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Abstract

Late preterm (LP) infants are defined as those born at 34-0/7 to 36-6/7 weeks’ gestational age. LP infants were previously referred to as near term infants. The change in terminology resulted from the understanding that these infants are not fully mature and that the last 6 weeks of gestation represent a critical period of growth and development of the fetal brain and lungs, and of other systems. There is accumulating evidence of higher risks for health complications in these infants, including serious morbidity and a threefold higher infant mortality rate compared with term infants. This information is of critical importance because of its scientific merits and practical implications. However, it warrants a critical and balanced review, given the apparent overall uncomplicated outcome for the majority of LP infants.

Others reviewed the characteristics of LP infants that predispose them to a higher risk of morbidity at the neonatal period. This review focuses on the long-term neurodevelopmental and respiratory outcomes, with the main aim to suggest putative prenatal, neonatal, developmental, and environmental causes for these increased morbidities. It demonstrates parallelism in the trajectories of pulmonary and neurologic development and evolution as a model for fetal and neonatal maturation. These may suggest the critical developmental time period as the common pathway that leads to the outcomes. Disruption in this pathway with potential long-term consequences in both systems may occur if the intrauterine milieu is disturbed. Finally, the review addresses the practical implications on perinatal and neonatal care during infancy and childhood.

  • late preterm infants
  • neurodevelopmental
  • respiratory
  • outcomes
  • Abbreviations:
    BPD —
    bronchopulmonary dysplasia
    FRC —
    functional residual capacity
    GA —
    gestational age
    IUGR —
    intrauterine growth retardation
    LP —
    late preterm
    PVL —
    periventricular leukomalacia
    RDS —
    respiratory distress syndrome
    RSV —
    respiratory syncitial virus
    SGA —
    small for gestational age
    TTN —
    transient tachypnea of the newborn
    • Accepted July 24, 2013.
    • Copyright © 2013 by the American Academy of Pediatrics

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    Pediatrics
    Vol. 132, Issue 4
    1 Oct 2013
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    Late Preterm Infants: Near Term But Still in a Critical Developmental Time Period
    Amir Kugelman, Andrew A. Colin
    Pediatrics Oct 2013, 132 (4) 741-751; DOI: 10.1542/peds.2013-1131

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    Late Preterm Infants: Near Term But Still in a Critical Developmental Time Period
    Amir Kugelman, Andrew A. Colin
    Pediatrics Oct 2013, 132 (4) 741-751; DOI: 10.1542/peds.2013-1131
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    • Table of Contents

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    • Article
      • Abstract
      • Introduction
      • Late Prematurity: Scope of the Phenomenon, Mortality, and Neonatal Morbidity
      • Long-Term Morbidity of LP Infants
      • Practical Implications
      • Summary
      • Acknowledgment
      • Footnotes
      • References
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    • Comments

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    Subjects

    • Fetus/Newborn Infant
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    • late preterm infants
    • neurodevelopmental
    • respiratory
    • outcomes
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