Prematurity, defined as the birth of a newborn before 37 weeks of gestation. While internationally it is estimated that 1 in 10 newborns is born prematurely, in developed countries, including Greece, where infertility treatments have improved significantly, and multiple and complicated pregnancies have increased, the rates of prematurity are estimated to be even higher.

Late preterm neonates

Undoubtedly, the more premature and underweight a newborn is born, the greater the risk of health complications. Babies born between 34 and 36 weeks are a subgroup of babies, often referred to as late preterm babies, who the general population mistakenly believes are not at risk because they are ‘near term’. While these newborns have low mortality rates and will manage to return to their families mostly healthy, they may face short-term and long-term problems.

The processes of adaptation and transition of these newborns to the extrauterine environment are immature. They often experience respiratory difficulties, temperature instability, hypoglycemia, jaundice and feeding problems and as a result are admitted to the Neonatal Intensive Care Unit separated from their parents. While it is reassuring that the short-term problems of these newborns are reversible, the birth experience for the family is ultimately stressful with increased overall health care costs.

It is important that mothers receive prenatal counseling regarding the vulnerability of late preterm infants and that every effort be made to offer each mother prenatal interventions (corticoids, magnesium, delayed umbilical cord ligation) that have been shown to reduce morbidity of premature newborns. Ideally uncomplicated pregnancies should reach term at 40 weeks and high-risk pregnancies closer to 37 weeks. Certainly at all gestational ages, the risks of continuing the pregnancy must be carefully weighed against the risks of labor and the associated risk of prematurity.

Babies with mild prematurity are born before brain development is complete. Growth in brain volume, cerebellum, gray matter, and white matter myelination is rapid at the end of the third trimester of pregnancy, between 34 and 40 weeks. In late-term neonates, the intrauterine maturation of the brain is interrupted, predisposing this population to developmental disorders.

International data indicate that the late preterm infant will require close developmental monitoring despite an apparently healthy presentation. Parents, pediatricians, and educational professionals should monitor these patients for problems with behavior, speech, motor skills, and possible school underachievement in order to provide timely referrals for specific treatments. It has been systematically demonstrated that early intervention by physical therapists, speech therapists, and occupational therapists even from the first six months of life significantly improves the neurodevelopmental outcome of infants with mild prematurity.