Specific Risks for the Preterm Infant

  • Emily A. Kieran
  • Colm P. F. O’DonnellEmail author
Reference work entry


Preterm birth – birth before 37 completed weeks of gestation – occurs in approximately 5–18% of births worldwide. Babies born preterm have increased mortality and are at a greater risk of morbidity and long-term adverse outcomes than infants born at term. Though the rate of preterm birth is relatively lower in developed countries than in developing countries, prematurity is the leading cause of neonatal mortality in both developing and developed countries. Infants born prematurely have less time to develop in utero, and their organs and body systems are still undergoing physiological development process at the time of birth. This immaturity of body organs combined with low birth weight puts preterm infants at risk of developing various short- and long-term complications. Babies born extremely preterm (<28 weeks of gestation) are at highest risk of developing medical problems that are specific and unique to the preterm population, and they should be managed differently to term infants during hospitalization in the neonatal period.


Infant, newborn Premature Respiratory distress syndrome Apnoea Retinopathy Necrotizing enterocolitis 


  1. Adams-Chapman I, Hansen NI, Stoll BJ, et al. NICHD Research Network. Neurodevelopmental outcome of ELBW infants with posthemorrhagic hydrocephalus requiring shunt insertion. Pediatrics. 2008; 121:e1167–77.PubMedPubMedCentralCrossRefGoogle Scholar
  2. Aziz A, Ohlsson A. Surfactant for pulmonary haemorrhage in neonates. Cochrane Database Syst Rev. 2012;7:CD005254.Google Scholar
  3. Bhutta AT, Cleves MA, Casey PH, Cradock MM, Anand KJ. Cognitive and behavioural outcomes of school aged children who were born preterm: a meta-analysis. JAMA. 2002;288:728–37.PubMedCrossRefPubMedCentralGoogle Scholar
  4. Bulkowstein S, Ben-Shimol S, Givon-Lavi N, Melamed R, Shany E, Greenberg D. Comparison of early onset sepsis and community-acquired late onset sepsis in infants less than 3 months of age. BMC Pediatr. 2016;16:82.PubMedPubMedCentralCrossRefGoogle Scholar
  5. Chernick V. Continuous distending pressure in hyaline membrane disease: of devices, disadvantages, and a daring study. Pediatrics. 1973;52(1):114–5.PubMedPubMedCentralGoogle Scholar
  6. Costeloe KL, Hennessy EM, Haider S, Stacey F, Marlow N, Draper ES. Short term outcomes after extreme preterm birth in England: comparison of two birth cohorts in 1995 and 2006 (the EPICure studies). BMJ. 2012;345:e7976.PubMedPubMedCentralCrossRefGoogle Scholar
  7. Cox JMR, Boehm JJ, Millare EA. Individual nasal masks and intranasal tubes: a non-invasive neonatal technique for the delivery of continuous positive airway pressure (CPAP). Anaesthesia. 1974;29:597–600.PubMedCrossRefPubMedCentralGoogle Scholar
  8. Dempsey EM, Barrington KJ. Diagnostic criteria and therapeutic interventions for the hypotensive very low birth weight infant. J Perinatol. 2006;26:677–81.PubMedCrossRefGoogle Scholar
  9. Dempsey EM, Barrington KJ. Treating hypotension in the preterm infant: when and with what: a critical and systematic review. J Perinatol. 2007;27:469–78.PubMedCrossRefPubMedCentralGoogle Scholar
  10. Dyet LE, Kennea N, Counsell SJ, Maalouf EF, Ajayi-Obe M, Duggan PJ, Harrison M, Allsop JM, Hajnal J, Herlihy AH, Edwards B, Laroche S, Cowan FM, Rutherford MA, Edwards AD. Natural history of brain lesions in extremely preterm infants studied with serial magnetic resonance imaging from birth and neurodevelopmental assessment. Pediatrics. 2006;118:536–48.PubMedCrossRefGoogle Scholar
  11. Enhorring G, Shennan A, Possmayer F, Dunn M, Chen CP, Milligan J. Prevention of neonatal respiratory distress syndrome by tracheal instillation of surfactant: a randomized clinical trial. Pediatrics. 1985;76(2):145–53.Google Scholar
  12. Fitzgibbons SC, Ching Y, Yu D, et al. Mortality of necrotizing enterocolitis expressed by birth weight categories. J Pediatr Surg. 2009;44:1072–5.PubMedCrossRefPubMedCentralGoogle Scholar
  13. Fujiwara T, Maeta H, Chida S, Morita T, Watabe Y, Abe T. Artificial surfactant therapy in hyaline-membrane disease. Lancet. 1980;1:55–9.PubMedCrossRefPubMedCentralGoogle Scholar
  14. Gamsu HR, Mullinger BM, Donnai P, Dash CH. Antenatal administration of betamethasone to prevent respiratory distress syndrome in preterm infants: report of a UK multicentre trial. Br J Obstet Gynaecol. 1989;96:401–10.PubMedCrossRefPubMedCentralGoogle Scholar
  15. Hallman M, Merritt TA, Jarvenpaa A-L, et al. Exogenous human surfactant for treatment of severe respiratory distress syndrome: a randomized prospective clinical trial. J Pediatr. 1985;106:963–9.PubMedCrossRefGoogle Scholar
  16. Hintz SR, Kendrick DE, Stoll BJ, Vohr BR, Fanaroff AA, Donovan EF, Poole WK, Blakely ML, Wright L, Higgins R, for the NICHD Neonatal Research Network. Neurodevelopmental and growth outcomes of extremely low birth weight infants after necrotising enterocolitis. Pediatrics. 2005;115:696–703.PubMedCrossRefGoogle Scholar
  17. Horbar JD, Carpenter JH, Badger GJ, Kenny MJ, Soll RF, Morrow KA, Buzas JS. Mortality and neonatal morbidity among infants 501–1500 grams from 2000 to 2009. Pediatrics. 2012;129:1019–26.PubMedCrossRefPubMedCentralGoogle Scholar
  18. Jobe AH. Pulmonary surfactant therapy. N Engl J Med. 1993;328:861–8.PubMedCrossRefPubMedCentralGoogle Scholar
  19. Kattwinkel J, Fleming D, Cha CC, Fanaroff AA, Klaus MH. A device for administration of continuous positive airway pressure by the nasal route. Pediatrics. 1973;52:131–4.PubMedGoogle Scholar
  20. Kumar VH, Clive J, Rosenkrantz TS, Bourque MD, Hussain N. Inguinal hernia in preterm infants (≤ 32 weeks gestation). Pediatr Surg Int. 2002;18:147–52.PubMedCrossRefPubMedCentralGoogle Scholar
  21. Liggins GC, Howie RN. A controlled trial of antepartum glucocorticoid treatment for prevention of the respiratory distress syndrome in premature infants. Pediatrics. 1972;50(4):515–25.PubMedPubMedCentralGoogle Scholar
  22. Lissauer T, Fanaroff AA. Neonatology at a glance. 2nd ed. Chichester/Malden: Wiley-Blackwell Press; 2011. Hoboken NJ, USA.Google Scholar
  23. Marlow N, Wolke D, Bracewell MA, Samara M. Neurologic and developmental disability at six years of age after extremely preterm birth. N Engl J Med. 2005;352:9–19.PubMedCrossRefPubMedCentralGoogle Scholar
  24. Ment LR, Ehrenkranz RA, Duncan CC, Scott DT, Taylor KJW, Katz KH, Schneider KC, Makuch RW, Oh W, Vohr B, Philip AGS, Allan W. Low-dose indomethacin and prevention of intraventricular hemorrhage: a multicenter randomised controlled trial. Pediatrics. 1994;93(4):543–50.PubMedPubMedCentralGoogle Scholar
  25. Moore T, Hennessy EM, Myles J, Johnson SJ, Draper ES, Costeloe KL, Marlow N. Neurological and developmental outcome in extremely preterm children born in England in 1995 and 2006: the EPICure studies. BMJ. 2012;345:e7961.PubMedPubMedCentralCrossRefGoogle Scholar
  26. Morley CJ, Davis PG, Doyle LW, et al. Nasal CPAP or intubation at birth for very preterm infants. N Engl J Med. 2008;358:700–8.PubMedCrossRefPubMedCentralGoogle Scholar
  27. Moss RL, Dimmitt RA, Barnhart DC, et al. Laparotomy versus peritoneal drainage for necrotizing enterocolitis and perforation. N Engl J Med. 2006;354:2225–34.PubMedCrossRefGoogle Scholar
  28. National Institute for Health and Clinical Excellence. Neonatal jaundice. Clinical Guideline 98. 2016.
  29. Neu J, Walker WA. Necrotizing enterocolitis. N Engl J Med. 2011;364:255–64.PubMedPubMedCentralCrossRefGoogle Scholar
  30. Ohlsson A, Walia R, Shah SS. Ibuprofen for the treatment of patient ductus arteriosus in preterm and/or low birth weight infants. Cochrane Database Syst Rev. 2013;4:CD003481.Google Scholar
  31. Pammi M, Weisman LE. Late-onset sepsis in preterm infants: update on strategies for therapy and prevention. Expert Rev Anti-Infect Ther. 2015;13(4):487–504.PubMedGoogle Scholar
  32. Papageorglou AN, Desgranges MF, Masson M, Colle E, Shatz R, Gelfand MN. The antenatal use of betamethasone in the prevention of respiratory distress syndrome: a controlled double-blind study. Pediatrics. 1979;63:73–9.Google Scholar
  33. Papile LA, Burstein J, Burstein R, Koffler H. Incidence and evolution of subependymal and intraventricular haemorrhage: a study of infants with birthweights less than 1500 gm. J Pediatr. 1978;92:529–34.PubMedCrossRefPubMedCentralGoogle Scholar
  34. Papworth S, Cartlidge PHT. Pulmonary haemorrhage. Curr Paediatr. 2001;11:167–71.CrossRefGoogle Scholar
  35. Rees CM, Hall NJ, Eaton S, Pierro A. Surgical strategies for necrotising enterocolitis: a survey of practice in the United Kingdom. Arch Dis Child Fetal Neonatal Ed. 2005;90:F152–5.PubMedPubMedCentralCrossRefGoogle Scholar
  36. Rees CM, Pierro A, Eaton S. Neurodevelopmental outcomes of neonates with medically and surgically treated necrotising enterocolitis. Arch Dis Child Fetal Neonatal Ed. 2007;92:F193–8.PubMedCrossRefPubMedCentralGoogle Scholar
  37. Rees CM, Eaton S, Pierro A. National prospective surveillance study of necrotizing enterocolitis in neonatal intensive care units. J Pediatr Surg. 2010;45(7):1391–7.PubMedCrossRefGoogle Scholar
  38. Rennie JM, et al. Rennie and Roberton’s textbook of neonatology. 5th ed. Edinburgh: Churchill Livingstone Elsevier; 2012. London, UK.Google Scholar
  39. Rhodes PG, Hall RT. Continuous positive airway pressure delivered by face mask in infants with the idiopathic respiratory distress syndrome: a controlled study. Pediatrics. 1973;52:1–5.PubMedGoogle Scholar
  40. Schmidt B, Davis P, Moddemann D, Ohlsson A, Roberts R, Saigal S, Solimano A, Vincer M, Wright LL, for the Trial of Indomethacin Prophylaxis in Preterms Investigators. Long-term effects of indomethacin prophylaxis in extremely-low-birth-weight infants. N Engl J Med. 2001;344:1966–72.PubMedCrossRefPubMedCentralGoogle Scholar
  41. Schmidt B, Roberts R, Davis P, Doyle LW, Barrington KJ, Ohlsson A, Solimano A, Tin W, for the Caffeine for Apnea of Prematurity Trial Group. Caffeine therapy for apnea of prematurity. N Engl J Med. 2006;354:2112–20.PubMedCrossRefPubMedCentralGoogle Scholar
  42. Shapiro DL, Notter RH, Morin III FC, et al. Double-blind, randomised trial of a calf lung surfactant extract administered at birth to very premature infants for prevention of RDS. Pediatrics. 1985;76:593–9.PubMedPubMedCentralGoogle Scholar
  43. Soll R, Ozek E. Multiple versus single doses of exogenous surfactant for the prevention or treatment of neonatal respiratory distress syndrome. Cochrane Database Syst Rev. 2009;1:CD000141.Google Scholar
  44. Stoll BJ, Hansen NI, Bell EF, et al, Eunice Kennedy Shriver National Institute of Child Health and Human Development Neonatal Research Network. Neonatal outcomes of extremely preterm infants from the NICHD neonatal research network. Pediatrics. 2010; 126:443–56.Google Scholar
  45. SUPPORT Study Group. Early CPAP versus surfactant in extremely preterm infants. N Engl J Med. 2010;362:1970–9.CrossRefGoogle Scholar
  46. Van Overmeire B, Follens I, Hartmann S, Cretan WL, Van Acker KJ. Treatment of patient ductus arteriosus with ibuprofen. Arch Dis Child Fetal Neonatal Ed. 1997;76:179–84.CrossRefGoogle Scholar
  47. Wiswell TE. Expanded uses of surfactant therapy. Clin Perinatol. 2001;28:695–711.PubMedCrossRefPubMedCentralGoogle Scholar
  48. World Health Organization. Preterm birth. Fact sheet N° 363. 2015.
  49. Yee WH, Soraisham AS, Shah VS, Aziz K, Yoon W, Lee SK, the Canadian Neonatal Network. Incidence and timing of presentation of necrotizing enterocolitis in preterm infants. Pediatrics. 2012;129:e298–304.PubMedCrossRefPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2020

Authors and Affiliations

  • Emily A. Kieran
    • 1
    • 2
    • 3
  • Colm P. F. O’Donnell
    • 4
    • 5
    • 6
    Email author
  1. 1.Department of NeonatologyThe National Maternity HospitalDublinIreland
  2. 2.National Children’s Research CentreDublinIreland
  3. 3.School of Medicine and Medical ScienceUniversity College DublinDublinIreland
  4. 4.National Maternity HospitalDublinIreland
  5. 5.School of MedicineUniversity College DublinDublinIreland
  6. 6.National Children’s Research CentreCrumlinDublinIreland

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